Individual
LISA MUSTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 MONTGOMERY ST NE, MARIETTA, GA 30060-1440
(917) 992-7896
Mailing address
180 MONTGOMERY ST NE, MARIETTA, GA 30060-1440
(917) 992-7896
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006481
GA
1041C0700X
Clinical Social Worker
NY0829552
NY
Other
Enumeration date
12/24/2007
Last updated
06/07/2021
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