LISA M DEFAZIO (NPI# 1336374925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336374925 |
| Entity Type | Individual |
| Full Name | LISA M DEFAZIO |
| Credential | M.S.W., L.C.S.W. |
| Practice Address |
3734 7th Ave Suite 24 Kenosha WI 53140-5525 |
| Mailing Address |
6125 Green Bay Rd Ste 700 Kenosha WI 53142-2928 |
| Practice Telephone | 2626540487 |
| Practice Fax Number | 2626542434 |
| Mailing Telephone | 2626540487 |
| Mailing Fax Number | 2626542434 |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2019-10-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
7524-123 | WI | Behavioral Health & Social Service Providers |
| Street Address |
3734 7TH AVE SUITE 24 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53140-5525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922054519 | Ismael R Staromana | Anesthesiology | 3734 7th Ave, Dominican Building #15, Kenosha, WI 53140-5525 | 2006-05-25 |
| 1851527428 | Tara R Rullman | Counselor | 3734 7th Ave, Suite 12, Kenosha, WI 53140-5525 | 2009-06-09 |
| 1942474341 | Steven M Schwimmer, D.o. | Internal Medicine | 3734 7th Ave, Suite 27, Kenosha, WI 53140-5525 | 2008-04-16 |
| 1366627689 | Pradeep G. Kumar Md Inc | Clinic/Center | 3734 7th Ave, Suite 1, Kenosha, WI 53140-5525 | 2008-01-05 |
| 1356526743 | Vicki L Bartow | Social Worker | 3734 7th Ave, Suite 12, Kenosha, WI 53140-5525 | 2008-01-03 |
| 1104001999 | Amy F Fockler | Social Worker | 3734 7th Ave, Suite 12, Kenosha, WI 53140-5525 | 2007-12-31 |
| 1275652315 | Corrie Ruth Lee | Counselor | 3734 7th Ave, Suite 24, Kenosha, WI 53140-5525 | 2007-03-28 |
| 1023153947 | Leilane U Sta Romana Mdsc | Internal Medicine | 3734 7th Ave, Dominican Building Suite 15, Kenosha, WI 53140-5525 | 2007-02-20 |
| 1730246380 | Ashokkumar K Shah | Psychiatry & Neurology | 3734 7th Ave, Suite 24, Kenosha, WI 53140-5525 | 2007-01-02 |
| 1255494852 | Ernesto Buencamino Md Sc | Internal Medicine | 3734 7th Ave, Suite 11, Kenosha, WI 53140-5525 | 2006-12-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225663396 | Lydia Zopf | Counselor | 2001 Alford Park Dr., Carthage College, Kenosha, WI 53140 | 2020-03-09 |
| 1952949406 | Rotate Rehabilitation and Performance | Physical Therapist | 5606 6th Avenue Suite Ll9, Kenosha, WI 53140 | 2019-12-16 |
| 1134778590 | Brenda Chiapetta | Registered Nurse | 3233 23rd Ave, Kenosha, WI 53140 | 2019-09-09 |
| 1275003394 | Kimberly Shaffner | Family Medicine | 4536 22nd Avenue, Kenosha, WI 53140 | 2018-12-01 |
| 1659863389 | Bart L Mengo | Contractor | 1715 60th Street, Kenosha, WI 53140 | 2018-05-30 |
| 1093182941 | Guided Wellness Counseling | Community/Behavioral Health | 1112 56th St, Kenosha, WI 53140 | 2015-08-26 |
| 1376970764 | Stacey L Andersen | Acupuncturist | 5603 7th Ave, Kenosha, WI 53140 | 2013-10-01 |
| 1841467438 | Deborah Schwerdtfeger | Occupational Therapy Assistant | 3415 Sheridan Road, Woodstock Rehab Dept, Kenosha, WI 53140 | 2008-05-13 |
| 1942492020 | Rebecca Ann Burdette | Counselor | 920 60th Street, Renosha, WI 53140 | 2007-08-13 |
| 1851598619 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 2707 15th Place, Kenosha, WI 53140 | 2007-06-27 |
| Find all providers in zip 53140 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881228559 | Beloved Wellness Center, LLC | Social Worker | 3535 30th Ave Ste 207, Kenosha, WI 53144-1632 | 2020-03-02 |
| 1457981730 | Robyn Aronin | Social Worker | 8331 64th St, Kenosha, WI 53142-7578 | 2020-01-25 |
| 1659918324 | Kelly Sue Renzoni | Social Worker | 6125 Green Bay Rd Ste 700, Kenosha, WI 53142-2928 | 2019-12-02 |
| 1932603545 | Janice Finerty Lcsw LLC | Social Worker | 6520 67th St, Kenosha, WI 53142-1403 | 2018-03-19 |
| 1750747325 | Shellie K Babcock, Lcsw LLC | Social Worker | 705 50th St, Kenosha, WI 53140-3336 | 2016-01-12 |
| 1043683451 | Andrew S Bailey | Social Worker | 3601 30th Ave Suite 102, Kenosha, WI 53144-1642 | 2015-11-06 |
| 1124390869 | Victoria Mahboub | Social Worker | 6014 41st Ave, Kenosha, WI 53142-7025 | 2012-01-26 |
| 1750663480 | Thomas Michael Plaga | Social Worker | 5712 66th Pl, Kenosha, WI 53142-1237 | 2011-09-20 |
| 1114226826 | Shonda Lynn Gagliano | Social Worker | 7723 32nd Ave, Kenosha, WI 53142-4606 | 2011-03-21 |
| 1750403101 | Susan Marie Panger | Social Worker | 811 60th St, 2e, Kenosha, WI 53140-4074 | 2007-04-05 |
| Find all providers in KENOSHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.