Provider Demographics
NPI:1598278038
Name:AUDINO, LISA A (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:AUDINO
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:ME
Mailing Address - Zip Code:04921-0115
Mailing Address - Country:US
Mailing Address - Phone:207-505-6082
Mailing Address - Fax:
Practice Address - Street 1:467 HADLEY MILL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:ME
Practice Address - Zip Code:04921-3119
Practice Address - Country:US
Practice Address - Phone:207-505-6082
Practice Address - Fax:330-266-7303
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC186341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical