MEDICARE: MS. LISA CARAISCO 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
1	1041C0700X	Clinical Social Worker	R047537-1	NY

General Provider Information

NPI Number	:	1578575577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA CARAISCO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 44
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-0044
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:	914-762-1946

Provider Business Practice Location Address
First Line	:	2094 ALBANY POST ROAD
Second Line	:	VA HUDSON VALLEY HEALTH CARE - MENTAL HEALTH
City	:	MONTROSE
State	:	NY
Zip	:	10548-0100
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:	914-788-4286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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