Provider Demographics
NPI:1609995232
Name:POLAKOWSKI, LISA E (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:POLAKOWSKI
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GARTLEY ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6431
Mailing Address - Country:US
Mailing Address - Phone:207-558-3510
Mailing Address - Fax:
Practice Address - Street 1:19 GARTLEY ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250-6431
Practice Address - Country:US
Practice Address - Phone:207-558-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC131601041C0700X, 1041C0700X
MELSX10099171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator