Provider Demographics
NPI:1508349689
Name:JOSEPHSON, LIZA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LIZA
Middle Name:BETH
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:B
Other - Last Name:JOSEPHSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:66 CEDAR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2646
Mailing Address - Country:US
Mailing Address - Phone:860-471-3507
Mailing Address - Fax:
Practice Address - Street 1:66 CEDAR ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-471-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical