Lisa Marie Scully, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP021117 Issued in PA

Practice address

100 Presidential Blvd Lbby G1
Bala Cynwyd, PA 19004-1108

Phone

(484) 270-8817

NPI assigned

Nov 6, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1770127326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PRESIDENTIAL BLVD LBBY G1",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041108",
            "telephone_number": "484-270-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PRESIDENTIAL BLVD LBBY G1",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041108",
            "telephone_number": "484-270-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCULLY",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-06",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP021117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.