Provider Demographics
NPI:1497037105
Name:GELORMINI, LISA (LICSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GELORMINI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ESSEX RD
Mailing Address - Street 2:LAHEY IPSWICH
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2599
Mailing Address - Country:US
Mailing Address - Phone:978-356-5533
Mailing Address - Fax:978-356-0218
Practice Address - Street 1:36 ESSEX RD
Practice Address - Street 2:LAHEY IPSWICH
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2599
Practice Address - Country:US
Practice Address - Phone:978-356-5533
Practice Address - Fax:978-356-0218
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2187201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical