Provider Demographics
NPI:1104902501
Name:STURM, LISA A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STURM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2988
Mailing Address - Country:US
Mailing Address - Phone:973-903-1205
Mailing Address - Fax:
Practice Address - Street 1:1020 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2988
Practice Address - Country:US
Practice Address - Phone:973-903-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053959001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical