Provider Demographics
NPI:1902318496
Name:BRESLIN, LISA PAIGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:PAIGE
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:PAIGE
Other - Last Name:BATEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4401 FAIRFAX DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1622
Mailing Address - Country:US
Mailing Address - Phone:571-328-7408
Mailing Address - Fax:
Practice Address - Street 1:4401 FAIRFAX DR STE 205
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1622
Practice Address - Country:US
Practice Address - Phone:571-328-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005469103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral