Provider Demographics
NPI:1366571796
Name:SANSOUCY, LISA ANNE (MA CAGS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:SANSOUCY
Suffix:
Gender:F
Credentials:MA CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 KENBERMA RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3951
Mailing Address - Country:US
Mailing Address - Phone:508-479-9310
Mailing Address - Fax:
Practice Address - Street 1:91 KENBERMA RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3951
Practice Address - Country:US
Practice Address - Phone:508-479-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health