Healthcare Provider Details

I. General information

NPI: 1306178199
Provider Name (Legal Business Name): LISA R ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA RENEE MORIN LCSW

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS AVE STE A&B
LEWISTON ME
04240-6040
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-755-3434
  • Fax: 207-755-3474
Mailing address:
  • Phone: 207-777-8950
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC12909
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: