Provider Demographics
NPI:1619479573
Name:HAVERSTICK, LISA P (RDN,CNSC,FAND)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:P
Last Name:HAVERSTICK
Suffix:
Gender:F
Credentials:RDN,CNSC,FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 SOUTH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6472
Mailing Address - Country:US
Mailing Address - Phone:973-971-7101
Mailing Address - Fax:973-290-7518
Practice Address - Street 1:435 SOUTH ST STE 330
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6472
Practice Address - Country:US
Practice Address - Phone:973-971-7101
Practice Address - Fax:973-290-7518
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic