Provider Demographics
NPI:1336469089
Name:LANDOLT, LISA R (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:LANDOLT
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 WEST HOLLIS STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-809-1534
Mailing Address - Fax:
Practice Address - Street 1:589 WEST HOLLIS STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-809-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical