Provider Demographics
NPI:1447752670
Name:WAJERT, LISA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:WAJERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BRIANNA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5004
Mailing Address - Country:US
Mailing Address - Phone:267-566-5882
Mailing Address - Fax:
Practice Address - Street 1:2935 BYBERRY RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2815
Practice Address - Country:US
Practice Address - Phone:215-957-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist