Provider Demographics
NPI:1700348265
Name:LISA FERRETTI LISW LLC
Entity Type:Organization
Organization Name:LISA FERRETTI LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-440-0751
Mailing Address - Street 1:1221 PARK PL NE STE F
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2019
Mailing Address - Country:US
Mailing Address - Phone:319-440-0751
Mailing Address - Fax:319-409-8071
Practice Address - Street 1:1221 PARK PL NE STE F
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2019
Practice Address - Country:US
Practice Address - Phone:319-440-0751
Practice Address - Fax:319-409-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA104339000Medicaid