Provider Demographics
NPI:1841314291
Name:KACENJAR, LISA A (LISW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:KACENJAR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 RIDGEDALE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1831
Mailing Address - Country:US
Mailing Address - Phone:440-230-5278
Mailing Address - Fax:
Practice Address - Street 1:5550 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2541
Practice Address - Country:US
Practice Address - Phone:440-885-0378
Practice Address - Fax:440-886-5873
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008368101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor