Provider Demographics
NPI:1316150188
Name:FAWCETT, LISA (LCSW LP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:LCSW LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WEST 86TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-724-6959
Mailing Address - Fax:
Practice Address - Street 1:156 WEST 86TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-724-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000226102L00000X
NY070944104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker