Provider Demographics
NPI:1982951448
Name:WESSAN, LISA TAMI (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:TAMI
Last Name:WESSAN
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 1:16 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1626
Mailing Address - Country:US
Mailing Address - Phone:978-710-8039
Mailing Address - Fax:978-455-0660
Practice Address - Street 1:16 MAIN ST
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1626
Practice Address - Country:US
Practice Address - Phone:978-710-8039
Practice Address - Fax:978-455-0660
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170201041C0700X
NY0722401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical