Provider Demographics
NPI:1891983177
Name:DACIERNO, LISA BRETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BRETTE
Last Name:DACIERNO
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 1:901 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4511
Mailing Address - Country:US
Mailing Address - Phone:291-357-2715
Mailing Address - Fax:201-833-8858
Practice Address - Street 1:901 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4511
Practice Address - Country:US
Practice Address - Phone:291-357-2715
Practice Address - Fax:201-833-8858
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical