Provider Demographics
NPI:1538423876
Name:WINEBURG, LISA M (LCSW-BACS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:WINEBURG
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:RUFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:2439 MANHATTAN BLVD STE 304
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-333-6657
Mailing Address - Fax:504-373-6193
Practice Address - Street 1:2439 MANHATTAN BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-333-6657
Practice Address - Fax:504-373-6193
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA95731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical