Individual
LISA M DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W., L.C.S.W.
Contact information
Practice address
3734 7TH AVE, SUITE 24, KENOSHA, WI 53140-5525
(262) 654-0487
(262) 654-2434
Mailing address
6125 GREEN BAY RD, STE 700, KENOSHA, WI 53142-2928
(262) 654-0487
(262) 654-2434
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7524-123
WI
Other
Enumeration date
05/26/2009
Last updated
10/10/2019
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