Provider Demographics
NPI:1023840287
Name:LAGNESE, CAROLINE (LISAC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LAGNESE
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:LAGNESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4201 N 16TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5398
Mailing Address - Country:US
Mailing Address - Phone:602-264-6214
Mailing Address - Fax:602-265-2102
Practice Address - Street 1:4201 N 16TH ST STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5398
Practice Address - Country:US
Practice Address - Phone:602-264-6214
Practice Address - Fax:602-265-2102
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10930101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)