Provider Demographics
NPI:1134250301
Name:LASORSA, LISA (RD LAC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LASORSA
Suffix:
Gender:F
Credentials:RD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BRUCE PARK AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-2705
Mailing Address - Country:US
Mailing Address - Phone:203-536-3923
Mailing Address - Fax:
Practice Address - Street 1:290 BRUCE PARK AVE APT 2
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2705
Practice Address - Country:US
Practice Address - Phone:203-536-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0756133V00000X
CT10172171100000X
NY01685171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered