Provider Demographics
NPI:1891548269
Name:SMITH, LISA LENORE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LENORE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ELIZABETH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2257
Mailing Address - Country:US
Mailing Address - Phone:973-558-8750
Mailing Address - Fax:
Practice Address - Street 1:315 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1383
Practice Address - Country:US
Practice Address - Phone:973-558-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06441100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker