Provider Demographics
NPI:1144555921
Name:COREY, LISA DIANE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:COREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LELAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4961
Mailing Address - Country:US
Mailing Address - Phone:925-439-9628
Mailing Address - Fax:925-439-9639
Practice Address - Street 1:300 E LELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4961
Practice Address - Country:US
Practice Address - Phone:925-439-9628
Practice Address - Fax:925-439-9639
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker