Provider Demographics
NPI:1740223213
Name:STERN, LISA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:STERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1656 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1833
Mailing Address - Country:US
Mailing Address - Phone:516-374-3724
Mailing Address - Fax:
Practice Address - Street 1:207 GROVE AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1715
Practice Address - Country:US
Practice Address - Phone:516-569-6733
Practice Address - Fax:516-569-6917
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071098-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN48V51Medicare ID - Type Unspecified