Basic Information
| Provider Information | |||||||||
| NPI: | 1962836312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSARRA | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LSW, LCADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 193 | ||||||||
| Address2: | |||||||||
| City: | SHIP BOTTOM | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093846609 | ||||||||
| FaxNumber: | 6109816078 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 N. BAY AVENUE, UNIT #1 | ||||||||
| Address2: | |||||||||
| City: | BEACH HAVEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093846609 | ||||||||
| FaxNumber: | 6109816078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2013 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 37LC00237100 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.