Provider Demographics
NPI:1588899090
Name:PHILLIPS, LISA MARIE (LCSW, CASAC-M)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW, CASAC-M
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, CASAC-M
Mailing Address - Street 1:239 GOLDEN HILL LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6452
Mailing Address - Country:US
Mailing Address - Phone:845-486-2703
Mailing Address - Fax:845-383-1729
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6452
Practice Address - Country:US
Practice Address - Phone:845-486-2703
Practice Address - Fax:845-383-1729
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY101227104100000X
NY0936581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker