MEDICARE: LISA A. VERNI, LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC04549300NJ	NJ

General Provider Information

NPI Number	:	1013145416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA A. VERNI, LCSW, LLC

Provider Business Mailing Address
First Line	:	705 ATLANTIC AVE
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-2913
Country	:	US
Telephone Number	:	732-714-0997
Fax Number	:	732-899-1539

Provider Business Practice Location Address
First Line	:	705 ATLANTIC AVE
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-2913
Country	:	US
Telephone Number	:	732-714-0997
Fax Number	:	732-899-1539

Authorized Official
Title or Position	:	OWNER
Name	:	LISA ANN VERNI
Credential	:	LCSW
Telephone Number	:	732-714-0997

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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