Provider Demographics
NPI:1770857872
Name:MANN, LISA N (LMHC, CASAC, MSED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:MANN
Suffix:
Gender:F
Credentials:LMHC, CASAC, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9434
Mailing Address - Country:US
Mailing Address - Phone:716-816-5352
Mailing Address - Fax:
Practice Address - Street 1:8656 DELAMATER RD STE G
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9691
Practice Address - Country:US
Practice Address - Phone:716-817-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health