Provider Demographics
NPI:1114102555
Name:TWENTE, LISA ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:TWENTE
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 1:144 MERRIMACK ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1725
Mailing Address - Country:US
Mailing Address - Phone:781-249-0115
Mailing Address - Fax:
Practice Address - Street 1:144 MERRIMACK ST
Practice Address - Street 2:SUITE 310
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1725
Practice Address - Country:US
Practice Address - Phone:781-249-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical