Provider Demographics
NPI:1457564692
Name:KNOWLES-WARREN, LISA ANN (MED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KNOWLES-WARREN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WARE ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1551
Mailing Address - Country:US
Mailing Address - Phone:413-283-2216
Mailing Address - Fax:
Practice Address - Street 1:273 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1950
Practice Address - Country:US
Practice Address - Phone:413-736-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health