Basic Information
| Provider Information | |||||||||
| NPI: | 1841370483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LISBON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW ACSW LCSW DCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | LYONS CAMPUS, BLDG 57, ROOM 146 | ||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | 9086045850 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | LYONS CAMPUS, BLDG 57, ROOM 146 | ||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | 9086045850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW005596E | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.