MEDICARE: MS. IRAN ELIZABETH LISSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1003760836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRAN ELIZABETH LISSER

Provider Business Mailing Address
First Line	:	5601 RIVERDALE AVE APT 4A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-2120
Country	:	US
Telephone Number	:	917-627-1263
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 CONTINENTAL AVE
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-1425
Country	:	US
Telephone Number	:	917-627-1263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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