Provider Demographics
NPI:1487788691
Name:LISA C. SACCO, PSY.D., PLLC
Entity type:Organization
Organization Name:LISA C. SACCO, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:919-523-7607
Mailing Address - Street 1:107 BILLINGRATH TURN LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-2911
Mailing Address - Country:US
Mailing Address - Phone:919-523-7607
Mailing Address - Fax:
Practice Address - Street 1:1100 NW MAYNARD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8706
Practice Address - Country:US
Practice Address - Phone:919-428-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty