Provider Demographics
NPI:1346845526
Name:LISA BIOTY, LLC
Entity Type:Organization
Organization Name:LISA BIOTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIOTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-215-8097
Mailing Address - Street 1:237 TWIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1795
Mailing Address - Country:US
Mailing Address - Phone:203-215-8097
Mailing Address - Fax:
Practice Address - Street 1:237 TWIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-1795
Practice Address - Country:US
Practice Address - Phone:203-215-8097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT044721016Medicaid