Provider Demographics
NPI:1205931730
Name:STORTO-FEATHERSTON, LISA J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:STORTO-FEATHERSTON
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:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60536-0133
Mailing Address - Country:US
Mailing Address - Phone:630-742-2755
Mailing Address - Fax:
Practice Address - Street 1:215 HILLCREST AVE STE F
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-425-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0058091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02227589OtherBCBS PROVIDER #