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NPI Code Detail

MEDICARE: LISA HEAD LCSW

MEDICARE: LISA HEAD LCSW
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
1104100000XSocial Worker
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1417587361
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA HEAD LCSW
Provider Business Mailing Address
First Line : 18 MILLER RD
Second Line :
City : MAHOPAC
State : NY
Zip : 10541-2220
Country : US
Telephone Number : 845-845-4897
Fax Number :
Provider Business Practice Location Address
First Line : 18 MILLER RD
Second Line :
City : MAHOPAC
State : NY
Zip : 10541-2220
Country : US
Telephone Number : 845-845-4897
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2020
Last Update Date : 06/27/2025

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Directions to “ LISA HEAD LCSW” Practice Location

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