Provider Demographics
NPI:1386862712
Name:THOMAS, LISA MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8854
Mailing Address - Country:US
Mailing Address - Phone:651-730-6661
Mailing Address - Fax:
Practice Address - Street 1:1013 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8854
Practice Address - Country:US
Practice Address - Phone:651-730-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical