Provider Demographics
NPI:1306379946
Name:RAETZ, LISA JOANNA (BSW,CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JOANNA
Last Name:RAETZ
Suffix:
Gender:F
Credentials:BSW,CASAC-T
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SUDBURY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2641
Mailing Address - Country:US
Mailing Address - Phone:585-690-3636
Mailing Address - Fax:
Practice Address - Street 1:55 TROUP ST
Practice Address - Street 2:CATHOLIC FAMILY CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2053
Practice Address - Country:US
Practice Address - Phone:585-546-3046
Practice Address - Fax:585-546-2607
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)