Provider Demographics
NPI:1679716021
Name:CASWELL, LISA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:CASWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903-9378
Mailing Address - Country:US
Mailing Address - Phone:607-562-8222
Mailing Address - Fax:
Practice Address - Street 1:711 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2322
Practice Address - Country:US
Practice Address - Phone:607-734-6151
Practice Address - Fax:607-734-2943
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074819-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-0795709Medicaid