Provider Demographics
NPI:1356000624
Name:KREZINSKI, LISEL MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:LISEL
Middle Name:MARIE
Last Name:KREZINSKI
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 1:84 SIMPLICITY ACRES
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4502
Mailing Address - Country:US
Mailing Address - Phone:802-793-0605
Mailing Address - Fax:
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4881
Practice Address - Country:US
Practice Address - Phone:802-479-3302
Practice Address - Fax:802-225-5720
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00008551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical