Organization
LISA M PUPA PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA M PUPA-O'SULLIVAN PHD (OWNER OPERATOR)
(732) 359-7675
Entity
Organization
Contact information
Practice address
2164 HIGHWAY 35 BLDG B, SEA GIRT, NJ 08750-1013
(732) 359-7675
(732) 359-7674
Mailing address
2164 HIGHWAY 35 BLDG B, SEA GIRT, NJ 08750-1013
(732) 359-7675
(732) 359-7674
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
35SI00351200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00667132
PTAN
—
Enumeration date
09/03/2010
Last updated
09/03/2010
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