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NPI Code Detail

MEDICARE: MRS. LISA JOANNA RAETZ BSW,CASAC-T

MEDICARE:  MRS. LISA JOANNA RAETZ  BSW,CASAC-T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1306379946
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA JOANNA RAETZ BSW,CASAC-T
Provider Business Mailing Address
First Line : 32 SUDBURY DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-2641
Country : US
Telephone Number : 585-690-3636
Fax Number :
Provider Business Practice Location Address
First Line : 55 TROUP ST
Second Line : CATHOLIC FAMILY CENTER
City : ROCHESTER
State : NY
Zip : 14608-2053
Country : US
Telephone Number : 585-546-3046
Fax Number : 585-546-2607
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2017
Last Update Date : 04/11/2017

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Directions to “ MRS. LISA JOANNA RAETZ BSW,CASAC-T” Practice Location

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