Provider Demographics
NPI:1780723767
Name:GRASSO, LISA KARVOSKI (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KARVOSKI
Last Name:GRASSO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:KARVOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:155 STORRS RD
Mailing Address - Street 2:A
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1638
Mailing Address - Country:US
Mailing Address - Phone:860-456-4442
Mailing Address - Fax:864-456-4068
Practice Address - Street 1:155 STORRS RD
Practice Address - Street 2:A
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1638
Practice Address - Country:US
Practice Address - Phone:860-456-4442
Practice Address - Fax:864-456-4068
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist