Provider Demographics
NPI:1578599502
Name:ALLEN, LISA A (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BRINKERHOFF ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2729
Mailing Address - Country:US
Mailing Address - Phone:518-578-3380
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL STE 123
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5901
Practice Address - Country:US
Practice Address - Phone:518-578-3380
Practice Address - Fax:518-566-0168
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072295-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072295-1OtherLCSW