Provider Demographics
NPI:1285708321
Name:RAIA, LISA FRANCES (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:FRANCES
Last Name:RAIA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0286
Mailing Address - Country:US
Mailing Address - Phone:631-360-6695
Mailing Address - Fax:
Practice Address - Street 1:269 E MAIN ST
Practice Address - Street 2:SUITE F2
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2832
Practice Address - Country:US
Practice Address - Phone:631-360-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075024-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6020754230Medicaid
NY6020754230Medicaid