Provider Demographics
NPI:1932349982
Name:STILES, LISA LORRAINE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:LORRAINE
Last Name:STILES
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LORRAINE
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:1295 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4717
Mailing Address - Country:US
Mailing Address - Phone:631-328-1651
Mailing Address - Fax:801-923-7211
Practice Address - Street 1:1295 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4717
Practice Address - Country:US
Practice Address - Phone:631-328-1651
Practice Address - Fax:801-923-7211
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071389-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical