Provider Demographics
NPI:1205719051
Name:CALVERT, LISA MARIE (CASAC-T40813)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:CASAC-T40813
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:CUDDEBACKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12729
Mailing Address - Country:US
Mailing Address - Phone:845-978-1369
Mailing Address - Fax:845-978-1369
Practice Address - Street 1:24 UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4906
Practice Address - Country:US
Practice Address - Phone:845-978-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40813101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor