Healthcare Provider Details

I. General information

NPI: 1780038331
Provider Name (Legal Business Name): LISA BETH WESTERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 SOUTH CANAAN ROAD
CANAAN CT
06018
US

IV. Provider business mailing address

PO BOX 717
CANAAN CT
06018-0717
US

V. Phone/Fax

Practice location:
  • Phone: 860-824-1397
  • Fax: 888-759-8752
Mailing address:
  • Phone: 860-824-1397
  • Fax: 888-759-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080624-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: