Healthcare Provider Details

I. General information

NPI: 1528081445
Provider Name (Legal Business Name): LISA MACKRES ICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WASHINGTON AVE SUITE 304
HAMDEN CT
06518
US

IV. Provider business mailing address

60 WASHINGTON AVE SUITE 304
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-2890
  • Fax: 203-281-2896
Mailing address:
  • Phone: 203-281-2890
  • Fax: 203-281-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number003408
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number003408
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: