Provider Demographics
NPI:1407806284
Name:FRADY, LISA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:FRADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:CRICHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1175 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3639
Mailing Address - Country:US
Mailing Address - Phone:352-446-2011
Mailing Address - Fax:352-385-0128
Practice Address - Street 1:1175 LUCERNE DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3639
Practice Address - Country:US
Practice Address - Phone:352-446-2011
Practice Address - Fax:352-385-0128
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 104701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2088872OtherCIGNA
FL273250802OtherMAGELLAN
FL273250802OtherTRICARE
TNTN01R5620547289R5OtherJOHNDEERE-BEHAVIOR HEALTH
FL273250802OtherHUMANA
FL273250802OtherPSYCHCARE
TN3927870OtherFEI-BEHAVIORAL HEALTH PRO
TN022688OtherVMC - BEHAVIORAL HEALTH P
TN11442656OtherCAQH-BEHAVIOR HEALTH PROV
FL832983633OtherUHC/UBH
FLA7820954OtherAETNA
TN000509OtherTENNCARE-BEH HEALTH PROV
TN5389124OtherAETNA-BEHAVIORAL HEALTH P
FL11442656OtherCAQH
FL166375OtherMHNETWORK
FL12885505OtherMULTIPLAN
TN264470000OtherMAGELLAN
TN4208400OtherBCBST
FL658507OtherVALUE OPTIONS
FL273250802OtherMAGELLAN
TN3927870OtherFEI-BEHAVIORAL HEALTH PRO
TN022688OtherVMC - BEHAVIORAL HEALTH P