Provider Demographics
NPI:1285694679
Name:LISI-HAAS, CAROLYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:LISI-HAAS
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 1:22 WALTER AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2040
Mailing Address - Country:US
Mailing Address - Phone:516-579-8910
Mailing Address - Fax:
Practice Address - Street 1:185 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2931
Practice Address - Country:US
Practice Address - Phone:516-921-8811
Practice Address - Fax:516-921-6313
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036036-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical