Provider Demographics
NPI:1255946976
Name:KAELIN, LISA (LCSW-R)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KAELIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KALIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:1513 CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2305
Mailing Address - Country:US
Mailing Address - Phone:315-794-2870
Mailing Address - Fax:
Practice Address - Street 1:1513 CRAIG ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2305
Practice Address - Country:US
Practice Address - Phone:315-794-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL135661041C0700X
NY0495331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical