Provider Demographics
NPI:1912398835
Name:FERRETTI, LISA (LISW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FERRETTI
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 BLAIRS FERRY RD NE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5891
Mailing Address - Country:US
Mailing Address - Phone:319-440-0751
Mailing Address - Fax:319-409-8071
Practice Address - Street 1:1957 BLAIRS FERRY RD NE
Practice Address - Street 2:SUITE 600
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5891
Practice Address - Country:US
Practice Address - Phone:319-440-0751
Practice Address - Fax:319-409-8071
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health