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General NPI Number Information
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NPI Number | 1255946976
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Entity Type | Individual
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Provider Name | LISA KAELIN LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 8142 LIMBERLOST RD
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City | CLINTON
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State | NY
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Zip | 13323-3610
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Country | US
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Telephone | 392-457-5147
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Fax | 315-982-5450
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Provider Business Mailing Address
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Address Line | 8142 LIMBERLOST RD
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City | CLINTON
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State | NY
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Zip | 13323-3610
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Country | US
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Telephone | 392-457-5147
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Fax | 315-982-5450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13566
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 049533
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License Number State | NY
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