Provider Demographics
NPI:1912270240
Name:MATHAI, LISA A (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MATHAI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 JOY WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9730
Mailing Address - Country:US
Mailing Address - Phone:304-657-5252
Mailing Address - Fax:
Practice Address - Street 1:108 JOY WAY
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9730
Practice Address - Country:US
Practice Address - Phone:304-657-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00938863104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker