Manderino, Lisa M

Manderino, Lisa M is an individual health care provider with primary practice located at 3615 Newburg Rd , Louisville KY 40218-3368. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as her primary health care specialty. Manderino, Lisa M can be contacted via phone (502) 909-0772.

Contact Information

Primary practice address
3615 Newburg Rd Louisville KY 40218-3368
Phone: (502) 909-0772
Fax: (855) 859-0123
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X

Profile Details

NPI number 1790288066
LBN Legal business name Manderino, Lisa M
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2018
Last updated Oct 13th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790288066 NPPES
Kentucky Other 276504 STATE LICENSE

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