Provider Demographics
NPI:1083258321
Name:GODNICK, LISANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISANNE
Middle Name:
Last Name:GODNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISANNE
Other - Middle Name:
Other - Last Name:GODNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 W 101 ST
Mailing Address - Street 2:
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:646-522-0114
Mailing Address - Fax:
Practice Address - Street 1:210 W 101 ST
Practice Address - Street 2:
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:646-522-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04027511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical