Healthcare Provider Details

I. General information

NPI: 1255500310
Provider Name (Legal Business Name): LISA REIGNIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WOODLAND ST
HARTFORD CT
06105-1233
US

IV. Provider business mailing address

27 RANDOLPH RD
HOWELL NJ
07731-8611
US

V. Phone/Fax

Practice location:
  • Phone: 860-241-0317
  • Fax:
Mailing address:
  • Phone: 718-298-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: