Provider Demographics
NPI:1043958978
Name:GREIST, LISBETH ANE (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:ANE
Last Name:GREIST
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-7815
Mailing Address - Country:US
Mailing Address - Phone:203-522-6023
Mailing Address - Fax:
Practice Address - Street 1:215 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7815
Practice Address - Country:US
Practice Address - Phone:203-522-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional