Provider Demographics
NPI:1225397045
Name:BISSONNETTE, LISE MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LISE
Middle Name:MARIE
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-4508
Mailing Address - Country:US
Mailing Address - Phone:508-679-8511
Mailing Address - Fax:508-672-2558
Practice Address - Street 1:2425 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-4508
Practice Address - Country:US
Practice Address - Phone:508-679-8511
Practice Address - Fax:508-672-2558
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical