Provider Demographics
NPI:1548417710
Name:NITTI, LISA (MSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:NITTI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41034 MARKS DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4932
Mailing Address - Country:US
Mailing Address - Phone:248-974-6248
Mailing Address - Fax:
Practice Address - Street 1:41034 MARKS DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4932
Practice Address - Country:US
Practice Address - Phone:248-974-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker