MEDICARE: DR. LISA YOUNGLING HOWARD M.D.

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	2084P0800X	Psychiatry Physician	038894	CT

General Provider Information

NPI Number	:	1831317262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA YOUNGLING HOWARD M.D.

Provider Business Mailing Address
First Line	:	149 UPPER CHURCH HILL RD
Second Line	:
City	:	WASHINGTON DEPOT
State	:	CT
Zip	:	06794-1612
Country	:	US
Telephone Number	:	860-567-4474
Fax Number	:	860-567-4474

Provider Business Practice Location Address
First Line	:	43 WEST ST
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3501
Country	:	US
Telephone Number	:	860-567-4474
Fax Number	:	860-567-4474

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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