Dewitt, Lisa Ellen

Dewitt, Lisa Ellen is an individual health care provider with primary practice located at 77 Cherry St , East Hartford CT 06108-2053. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Dewitt, Lisa Ellen can be contacted via phone (860) 428-9158.

Contact Information

Primary practice address
77 Cherry St East Hartford CT 06108-2053
Phone: (860) 428-9158
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Clinical 1041C0700X 007577 Connecticut

Profile Details

NPI number 1477561488
LBN Legal business name Dewitt, Lisa Ellen
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 4th, 2006
Last updated Mar 25th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477561488 NPPES
Connecticut MEDICAID 004040564

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