Individual
KIMBERLY LISACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9015 N 3RD ST, PHOENIX, AZ 85020-2444
(480) 882-4545
(602) 714-3755
Mailing address
7500 N DREAMY DRAW DR STE 145, PHOENIX, AZ 85020-4668
(480) 882-4545
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
006573
CT
1041C0700X
Clinical Social Worker
Primary
LCSW22455
AZ
Other
Enumeration date
11/03/2020
Last updated
03/20/2025
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