Provider Demographics
NPI:1487940805
Name:FACINELLI, LISA (LIC AC, MAOM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FACINELLI
Suffix:
Gender:F
Credentials:LIC AC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 HIGGINS CIR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-5010
Mailing Address - Country:US
Mailing Address - Phone:610-888-0370
Mailing Address - Fax:
Practice Address - Street 1:3543 W BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1900
Practice Address - Country:US
Practice Address - Phone:703-578-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist