Provider Demographics
NPI:1720218001
Name:STEIN, LISA SUE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUE
Last Name:STEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MIDDLE NECK RD
Mailing Address - Street 2:#2N
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1466
Mailing Address - Country:US
Mailing Address - Phone:516-708-1314
Mailing Address - Fax:
Practice Address - Street 1:444 MIDDLE NECK RD
Practice Address - Street 2:#2N
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1466
Practice Address - Country:US
Practice Address - Phone:516-708-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065973-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker