Provider Demographics
NPI:1689987976
Name:THALER, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THALER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 15TH ST
Mailing Address - Street 2:#GFW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6756
Mailing Address - Country:US
Mailing Address - Phone:212-675-7605
Mailing Address - Fax:
Practice Address - Street 1:119 W 15TH ST
Practice Address - Street 2:#GFW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6756
Practice Address - Country:US
Practice Address - Phone:212-675-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041745-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist