Provider Demographics
NPI:1023232154
Name:GOMIEN, LISA LAMOYNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:LAMOYNE
Last Name:GOMIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1230
Mailing Address - Country:US
Mailing Address - Phone:630-208-6263
Mailing Address - Fax:847-697-4717
Practice Address - Street 1:1497 N LA FOX ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1227
Practice Address - Country:US
Practice Address - Phone:630-208-6263
Practice Address - Fax:847-697-4717
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL964200OtherINSURANCE