Provider Demographics
NPI:1609334523
Name:LIZZI, DESIRAE (LSW)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:
Last Name:LIZZI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08829-1811
Mailing Address - Country:US
Mailing Address - Phone:908-343-7272
Mailing Address - Fax:
Practice Address - Street 1:425 AMWELL RD STE 1
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1213
Practice Address - Country:US
Practice Address - Phone:908-770-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NJ44L06372300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor