Provider Demographics
NPI:1447748405
Name:STACKPOLE, LISAMARIE LYN (CASAC-T, LMSW)
Entity Type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:LYN
Last Name:STACKPOLE
Suffix:
Gender:F
Credentials:CASAC-T, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BEVY CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6548
Mailing Address - Country:US
Mailing Address - Phone:347-207-7302
Mailing Address - Fax:
Practice Address - Street 1:43 BEVY CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-6548
Practice Address - Country:US
Practice Address - Phone:347-207-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY120241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)