Provider Demographics
NPI:1992870760
Name:KAZIAL, LISA M (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KAZIAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:KAZIAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, CASAC
Mailing Address - Street 1:3176 ABBOTT RD
Mailing Address - Street 2:BUILDING A, SUITE 500
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1069
Mailing Address - Country:US
Mailing Address - Phone:716-822-2117
Mailing Address - Fax:
Practice Address - Street 1:3176 ABBOTT RD
Practice Address - Street 2:BUILDING A, SUITE 500
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1069
Practice Address - Country:US
Practice Address - Phone:716-822-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY004156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000OtherMASTERS DEGREE