Provider Demographics
NPI:1053531749
Name:SANFORD, LISA J (LICSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:69 BELLEVUE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-4710
Mailing Address - Country:US
Mailing Address - Phone:978-372-6524
Mailing Address - Fax:
Practice Address - Street 1:69 BELLEVUE AVE # 1
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-4710
Practice Address - Country:US
Practice Address - Phone:978-372-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10272301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical