Provider Demographics
NPI:1770699084
Name:FRIESE, LISA MONROE (LISW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MONROE
Last Name:FRIESE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE AVE E
Mailing Address - Street 2:#1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1158
Mailing Address - Country:US
Mailing Address - Phone:216-479-5541
Mailing Address - Fax:330-664-5022
Practice Address - Street 1:4055 EMBASSY PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-1781
Practice Address - Country:US
Practice Address - Phone:216-621-5600
Practice Address - Fax:330-664-5022
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0001316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FRSW23882Medicare ID - Type Unspecified
P36484Medicare UPIN