Provider Demographics
NPI:1063823433
Name:AFFLITTO, LISA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:AFFLITTO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2606
Mailing Address - Country:US
Mailing Address - Phone:908-433-5812
Mailing Address - Fax:
Practice Address - Street 1:61 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2606
Practice Address - Country:US
Practice Address - Phone:908-433-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701OtherAGENCY MEDICAID