Provider Demographics
NPI:1417029125
Name:MEISSNER, LISA (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MEISSNER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 COREYS RD
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-7722
Mailing Address - Country:US
Mailing Address - Phone:518-359-2623
Mailing Address - Fax:518-359-8255
Practice Address - Street 1:206 COREYS RD
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-7722
Practice Address - Country:US
Practice Address - Phone:518-359-2623
Practice Address - Fax:518-359-8255
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03769911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55786BMedicaid