| Doctor Name: | DR. LISA JANE BACKUS |
| NPI Number: | 1770827677 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 003187 |
| Business Practice Address: | 129 Tolland Stage Rd Suite 1 Tolland, CT - 060842342 |
| Business Phone Number: | 8604540611 |
| Business Fax Number: | 8604540919 |
| Mailing Address: | Po Box 537, WILLINGTON |
| State: | CT |
| Postal Code: | 062790537 |
| Phone Number: | 8608374995 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 10/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 003187 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |