Provider Demographics
NPI:1508898347
Name:LYSAGHT, EDWARD M (LCSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:LYSAGHT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BULLMAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2332
Mailing Address - Country:US
Mailing Address - Phone:908-387-9224
Mailing Address - Fax:
Practice Address - Street 1:90 BULLMAN ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2332
Practice Address - Country:US
Practice Address - Phone:908-387-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052327001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical