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General NPI Number Information
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NPI Number | 1467622803
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Entity Type | Individual
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Provider Name | LISA CORSO MASOURAS MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 7171 VERDI LN
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-6580
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Country | US
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Telephone | 804-723-5014
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Fax |
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Provider Business Mailing Address
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Address Line | 7109 STUDLEY RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-6514
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Country | US
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Telephone | 804-310-5351
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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 | 0904006510
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License Number State | VA
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