Basic Information
| Provider Information | |||||||||
| NPI: | 1801538665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PISANI | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | MA, LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1480 | ||||||||
| Address2: | |||||||||
| City: | WAITSFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056731480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025605090 | ||||||||
| FaxNumber: | 8024199669 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054015284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028653450 | ||||||||
| FaxNumber: | 8028593309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2022 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 068.0134459 | VT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.