Provider Demographics
NPI:1083705164
Name:BAYNE, LISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11195 NW 5TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7937
Mailing Address - Country:US
Mailing Address - Phone:954-913-1696
Mailing Address - Fax:
Practice Address - Street 1:767 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-2831
Practice Address - Country:US
Practice Address - Phone:954-979-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 6917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health