Provider Demographics
NPI:1376818153
Name:ACHENBACH, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ACHENBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 HELDERBERG TRL
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:NY
Mailing Address - Zip Code:12023-2926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1738 HELDERBERG TRL
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:NY
Practice Address - Zip Code:12023-2926
Practice Address - Country:US
Practice Address - Phone:518-872-5151
Practice Address - Fax:518-872-2031
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077269104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker