Provider Demographics
NPI:1477025617
Name:LISA IWANOWSKI LCSW LLC
Entity Type:Organization
Organization Name:LISA IWANOWSKI LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IWANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-257-6047
Mailing Address - Street 1:1275 POST RD STE A11
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6061
Mailing Address - Country:US
Mailing Address - Phone:203-257-6047
Mailing Address - Fax:
Practice Address - Street 1:1275 POST RD STE A11
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6061
Practice Address - Country:US
Practice Address - Phone:203-257-6047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health