Provider Demographics
NPI:1427075365
Name:ELSWIT, LISA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:ELSWIT
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 1:18 REED CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1662
Mailing Address - Country:US
Mailing Address - Phone:203-414-9321
Mailing Address - Fax:
Practice Address - Street 1:45 S MAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2402
Practice Address - Country:US
Practice Address - Phone:203-414-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT181163OtherMHN
CT7496209OtherVALUE OPTIONS
CTCBHP6763LEMedicaid
CTP1128937OtherOXFORD
CT212296000OtherAETNA HMO
CT140004284CT01OtherBLUE CROSS/ BLUE SHIELD