Provider Demographics
NPI:1851692370
Name:AUSTIN, LAKISHA R (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:R
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RICHMERE RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3201
Mailing Address - Country:US
Mailing Address - Phone:617-755-6448
Mailing Address - Fax:
Practice Address - Street 1:1 WESTINGHOUSE PLZ STE A101
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2183
Practice Address - Country:US
Practice Address - Phone:617-539-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1222331041C0700X
MA2214521041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker