Provider Demographics
NPI:1861772568
Name:MENDELSON, LISA (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 CHURCH RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8182
Mailing Address - Country:US
Mailing Address - Phone:732-575-1930
Mailing Address - Fax:732-818-0050
Practice Address - Street 1:2446 CHURCH RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8182
Practice Address - Country:US
Practice Address - Phone:732-575-1930
Practice Address - Fax:732-818-0050
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00487000103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist