Provider Demographics
NPI:1588739254
Name:KUSHNER, LISA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:KUSHNER
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 1:8 ALLYN ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6720
Mailing Address - Country:US
Mailing Address - Phone:207-322-5703
Mailing Address - Fax:207-338-5297
Practice Address - Street 1:8 ALLYN ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6720
Practice Address - Country:US
Practice Address - Phone:207-322-5703
Practice Address - Fax:207-338-5297
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC68801041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME221180000Medicaid
ME0115Medicare ID - Type Unspecified
ME0115Medicare ID - Type Unspecified