Basic Information
| Provider Information | |||||||||
| NPI: | 1386128734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEZSO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, LADC, CCS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049764823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074748368 | ||||||||
| FaxNumber: | 2078720639 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049764823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074748368 | ||||||||
| FaxNumber: | 0747477794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2018 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LC7112 | ME | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | LC19319 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.