Healthcare Provider Details

I. General information

NPI: 1023053253
Provider Name (Legal Business Name): CARLA LISIO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2269 SAW MILL RIVER RD BUILDING 1A
ELMSFORD NY
10523-3832
US

IV. Provider business mailing address

40 RONNY CIR
HASTINGS ON HUDSON NY
10706-4023
US

V. Phone/Fax

Practice location:
  • Phone: 914-345-5900
  • Fax: 914-347-8859
Mailing address:
  • Phone: 914-478-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR055852-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: