Provider Demographics
NPI:1790241818
Name:STIVERS, LISA (LMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STIVERS
Suffix:
Gender:
Credentials:LMHC
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 546
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-0546
Mailing Address - Country:US
Mailing Address - Phone:585-245-1840
Mailing Address - Fax:
Practice Address - Street 1:244 W WATER ST STE 200
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2926
Practice Address - Country:US
Practice Address - Phone:607-737-5215
Practice Address - Fax:607-735-2192
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07532841Medicaid