Provider Demographics
NPI:1598942575
Name:MAZURE, LISA J (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:MAZURE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:SCHWAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:323 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1537
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:989-672-2199
Practice Address - Street 1:1332 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9288
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:989-672-3170
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010856941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical