Healthcare Provider Details

I. General information

NPI: 1487107421
Provider Name (Legal Business Name): DR. ANDREE DE LISSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE DANBURY HOSPITAL PSYCHIATRY
DANBURY CT
06810
US

IV. Provider business mailing address

29 DOGWOOD CT
GOLDENS BRIDGE NY
10526-1115
US

V. Phone/Fax

Practice location:
  • Phone: 914-907-3127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number004626
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4626
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: