Individual
CRYSTAL HODGE LIZANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
576 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 781-6485
Mailing address
576 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 781-6485
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2028103
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306839
—
MA
Enumeration date
06/11/2009
Last updated
06/11/2009
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