Provider Information for 1245775105
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LISA HULSIZER LCSW
Sex: Female
NPI: 1245775105
Last Updated: 2023-06-12
Certification Date: 2023-06-12
Certification Date: 2023-06-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1245775105 | ||||||||||||
| Enumeration Date | 2017-01-03 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 580 HARRISON ST TITUSVILLE, FL 32780-4911 United States Phone: 321-576-7629 | Fax: | ||||||||||||
| Primary Practice Address | 580 HARRISON ST TITUSVILLE, FL 32780-4911 United States Phone: 321-576-7629 | Fax: | ||||||||||||
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