Provider Demographics
NPI:1467622803
Name:MASOURAS, LISA CORSO (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CORSO
Last Name:MASOURAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 STUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-6514
Mailing Address - Country:US
Mailing Address - Phone:804-310-5351
Mailing Address - Fax:
Practice Address - Street 1:7171 VERDI LN
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-6580
Practice Address - Country:US
Practice Address - Phone:804-723-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical