Provider Demographics
NPI:1083903413
Name:LOONEY-SQUIRE, LISA (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOONEY-SQUIRE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WAREHAM RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 WAREHAM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1178
Practice Address - Country:US
Practice Address - Phone:508-748-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical