Provider Demographics
NPI:1245952522
Name:LIST, LISA CHERYL (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CHERYL
Last Name:LIST
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 1:10 AVON LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4031
Mailing Address - Country:US
Mailing Address - Phone:201-341-1844
Mailing Address - Fax:
Practice Address - Street 1:10 AVON LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4031
Practice Address - Country:US
Practice Address - Phone:201-341-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical