| Doctor Name: | LISSA CAPTAIN |
| NPI Number: | 1003196023 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW |
| License Number: | 44SC05310100 |
| Business Practice Address: | 294 Harrington Ave Closter, NJ - 076241912 |
| Business Phone Number: | 9736509078 |
| Business Fax Number: | |
| Mailing Address: | 200 Sussex St, PATERSON |
| State: | NJ |
| Postal Code: | 075032722 |
| Phone Number: | 9736509078 |
| Fax Number: | |
| NPI Enumeration Date: | 08/22/2011 |
| NPI Last Update Date: | 02/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC05310100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |