Provider Demographics
NPI:1417425075
Name:CANZANO, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CANZANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-1919
Mailing Address - Country:US
Mailing Address - Phone:609-577-7641
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST STE 243
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4547
Practice Address - Country:US
Practice Address - Phone:609-577-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058188001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical