| NPI | 1194888222 |
|---|---|
| Former Name | LISA C MYCANKA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8194) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3586) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-11-18 |