Provider Demographics
NPI:1588935878
Name:BERGSTRAESSER, LISA R (LCSW, LADC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:BERGSTRAESSER
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-5020
Mailing Address - Country:US
Mailing Address - Phone:203-417-7367
Mailing Address - Fax:
Practice Address - Street 1:152 DEER HILL AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7791
Practice Address - Country:US
Practice Address - Phone:203-417-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0032791041C0700X
CT000440101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004257516Medicaid
CT004123840Medicaid
CT008031626Medicaid
CT008017939Medicaid