Provider Demographics
NPI:1316009905
Name:TIETCHEN, LISA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:TIETCHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:SCHMIDBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2094 ALBANY POST ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548
Mailing Address - Country:US
Mailing Address - Phone:914-737-4400
Mailing Address - Fax:
Practice Address - Street 1:2094 ALBANY POST ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2209104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker