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General NPI Number Information
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NPI Number | 1316373806
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Entity Type | Individual
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Provider Name | LISA LEE RUESCH LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 26 COURT ST STE 600
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City | BROOKLYN
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State | NY
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Zip | 11242-1106
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Country | US
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Telephone | 929-266-6380
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Fax |
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Provider Business Mailing Address
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Address Line | 370 OCEAN PKWY APT 12B
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City | BROOKLYN
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State | NY
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Zip | 11218-4682
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Country | US
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Telephone | 347-446-3118
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Fax |
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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 | 087868-1
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License Number State | NY
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