Provider Demographics
NPI:1629048988
Name:ORANSOFF, LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ORANSOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-0191
Mailing Address - Country:US
Mailing Address - Phone:860-928-5904
Mailing Address - Fax:860-928-0634
Practice Address - Street 1:161 MASHAMNQUET RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259
Practice Address - Country:US
Practice Address - Phone:860-928-5904
Practice Address - Fax:860-928-0634
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT255027OtherMANAGED HEALTH NETWORK
CT060001505CT01OtherBLUE CROSS
ORW51107Medicare ID - Type Unspecified