Provider Demographics
NPI:1144384694
Name:DEFECIANI, LISA M (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:DEFECIANI
Suffix:
Gender:F
Credentials:LCSW-R
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 51
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913
Mailing Address - Country:US
Mailing Address - Phone:917-922-9701
Mailing Address - Fax:212-687-2780
Practice Address - Street 1:315 MADISON AVENUE
Practice Address - Street 2:SUITE 506
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:917-922-9701
Practice Address - Fax:212-687-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050606001041C0700X
NYR054904-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical