=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427703800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA SINGEISEN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2022
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2143 S TAMIAMI TRL # 43
-----------------------------------------------------
City | OSPREY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34229-9696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-395-9049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 471 PONDEROSA RD
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34293-6354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-234-6141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW5745
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------