Provider Demographics
NPI:1508572793
Name:MICHETTI, LISA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:MICHETTI
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 1:44 STISSING MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:PINE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12567-5422
Mailing Address - Country:US
Mailing Address - Phone:518-391-9511
Mailing Address - Fax:
Practice Address - Street 1:44 STISSING MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567-5422
Practice Address - Country:US
Practice Address - Phone:518-391-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical