Provider Demographics
NPI:1669911228
Name:ERWIN, LISA (LICSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:DERBY LINE
Mailing Address - State:VT
Mailing Address - Zip Code:05830-1177
Mailing Address - Country:US
Mailing Address - Phone:802-487-4597
Mailing Address - Fax:
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5530
Practice Address - Country:US
Practice Address - Phone:802-487-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01106181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical