Provider Demographics
NPI:1104073816
Name:CHERINO, LISA K (LMSW,LADAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:CHERINO
Suffix:
Gender:F
Credentials:LMSW,LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:01 SAGEBRUSH STREET
Mailing Address - Street 2:
Mailing Address - City:ISLETA
Mailing Address - State:NM
Mailing Address - Zip Code:87022-0000
Mailing Address - Country:US
Mailing Address - Phone:505-869-4863
Mailing Address - Fax:505-869-4881
Practice Address - Street 1:01 SAGEBRUSH STREET
Practice Address - Street 2:
Practice Address - City:ISLETA
Practice Address - State:NM
Practice Address - Zip Code:87022-0000
Practice Address - Country:US
Practice Address - Phone:505-869-4863
Practice Address - Fax:505-869-4881
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM044DBK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM044DBKOtherNEW MEXICO LICENSE