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NPI Code Detail

MEDICARE: LISA MARIE PHILLIPS LCSW, CASAC-M

MEDICARE:   LISA MARIE PHILLIPS  LCSW, CASAC-M
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
2104100000XSocial Worker101227NY
31041C0700XClinical Social Worker093658NY

General Provider Information

NPI Number : 1588899090
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE PHILLIPS LCSW, CASAC-M
Provider Business Mailing Address
First Line : 239 GOLDEN HILL LN
Second Line :
City : KINGSTON
State : NY
Zip : 12401-6452
Country : US
Telephone Number : 845-486-2703
Fax Number : 845-383-1729
Provider Business Practice Location Address
First Line : 239 GOLDEN HILL LN
Second Line :
City : KINGSTON
State : NY
Zip : 12401-6452
Country : US
Telephone Number : 845-486-2703
Fax Number : 845-383-1729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2009
Last Update Date : 06/28/2022

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