Provider Demographics
NPI:1063494318
Name:BROWNING, LISA MARIE EDIN (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE EDIN
Last Name:BROWNING
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:EDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:PO BOX 13905
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0066
Mailing Address - Country:US
Mailing Address - Phone:480-703-7950
Mailing Address - Fax:480-218-1895
Practice Address - Street 1:6344 E BROADWAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-703-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-24091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112733Medicare PIN