Provider Demographics
NPI:1780038331
Name:WESTERSON, LISA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETH
Last Name:WESTERSON
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-0717
Mailing Address - Country:US
Mailing Address - Phone:860-824-1397
Mailing Address - Fax:888-759-8752
Practice Address - Street 1:187 SOUTH CANAAN ROAD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018
Practice Address - Country:US
Practice Address - Phone:860-824-1397
Practice Address - Fax:888-759-8752
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080624-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical