Provider Demographics
NPI:1508743154
Name:MOSES, LISA AUSTIN (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:AUSTIN
Last Name:MOSES
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 1:7125 BIRCHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5232
Mailing Address - Country:US
Mailing Address - Phone:608-712-0790
Mailing Address - Fax:
Practice Address - Street 1:429 GAMMON PL STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1053
Practice Address - Country:US
Practice Address - Phone:608-824-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10137-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical