Provider Demographics
NPI:1518392455
Name:SUMMER, LISA RAE (LCAT, LMHC, MT-BC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RAE
Last Name:SUMMER
Suffix:
Gender:M
Credentials:LCAT, LMHC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2213
Mailing Address - Country:US
Mailing Address - Phone:774-232-6725
Mailing Address - Fax:
Practice Address - Street 1:202 WEST 40TH STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:774-232-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000790101YM0800X
MA000006494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health