Provider Demographics
NPI:1124373402
Name:LIVINGSTON, LISA KIMBERLY (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KIMBERLY
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3824
Mailing Address - Country:US
Mailing Address - Phone:510-295-8405
Mailing Address - Fax:
Practice Address - Street 1:2800 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2012
Practice Address - Country:US
Practice Address - Phone:563-445-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0077541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical