Provider Demographics
NPI:1093955486
Name:PISANO, LAUREN A (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:PISANO
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:PO BOX 351
Mailing Address - Street 2:RIVER VALLEY SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-381-9692
Mailing Address - Fax:
Practice Address - Street 1:3 QUARRY LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-4817
Practice Address - Country:US
Practice Address - Phone:860-381-9692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical