Provider Demographics
NPI:1215168935
Name:MALEK, LISA (LMSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MALEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MALEK-RENFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:550 LATONA RD
Mailing Address - Street 2:BLD. D, SUITE 401
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2700
Mailing Address - Country:US
Mailing Address - Phone:585-732-8829
Mailing Address - Fax:
Practice Address - Street 1:550 LATONA RD
Practice Address - Street 2:BLD. D, SUITE 401
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2700
Practice Address - Country:US
Practice Address - Phone:585-732-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075490-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker