Provider Demographics
NPI:1306075817
Name:LUCIANO, LISA G (LCSW, ACSW, CASAC-T)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:G
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:LCSW, ACSW, CASAC-T
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:G
Other - Last Name:LUCIANO-NORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, ACSW, CASAC-T
Mailing Address - Street 1:402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1342
Mailing Address - Country:US
Mailing Address - Phone:607-379-2701
Mailing Address - Fax:
Practice Address - Street 1:402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1342
Practice Address - Country:US
Practice Address - Phone:607-379-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0799621041C0700X
NY27344101YA0400X
NY21675841041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00079962Medicaid