Provider Demographics
NPI:1720416910
Name:OTHS, LISA (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OTHS
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 1:100B DANBURY ROAD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-6019
Mailing Address - Country:US
Mailing Address - Phone:475-241-7875
Mailing Address - Fax:
Practice Address - Street 1:100 B DANBURY ROAD
Practice Address - Street 2:SUITE 201A
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:475-241-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool