Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | PC007239 | PA |
N | 101YS0200X | School Counselor | PA |
NPI | 1215359328 |
---|---|
Provider Name | Ms. Lisa Marie Mumau |
First Address | Connellsville, PA 15425-4003 |
Second Address | Connellsville, PA 15425-4003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2014 |
Last Update Date | 03/01/2019 |