Provider Demographics
NPI:1003868092
Name:CLOUTIER, LISA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BROWNSTONE RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9705
Mailing Address - Country:US
Mailing Address - Phone:860-651-9159
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST STE 22D
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-1904
Practice Address - Country:US
Practice Address - Phone:860-463-9535
Practice Address - Fax:860-831-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001734364SP0807X, 364SP0809X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult