Individual ProviderLisa K LaxSocial WorkerBehavioral Health & Social Service ProvidersPractice Address617 Riverside Ave, Burlington, VT 05401-1601(802) 864-6309PECOS EnrollmentThis provider is enrolled in PECOS as LISA LAX.Based on the most recent information from CMS, provider Lisa K Lax is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1417397647Provider TypeIndividualFull NameLax, Lisa KCredentialLICSWGenderFemaleSole ProprietorNoEnumeration Date7/2/2013Last Updated7/2/2013Contact InformationPractice LocationPractice Address617 Riverside Ave, Burlington, VT 05401-1601Phone(802) 864-6309Fax(802) 860-4313Mailing LocationMailing Address617 Riverside Ave, Burlington, VT 05401-1601Phone(802) 864-6309Fax(802) 860-4313Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense0890000134Vermont