Healthcare Provider Details

I. General information

NPI: 1508955352
Provider Name (Legal Business Name): MRS. LISA M SAENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST
FOREST HILLS NY
11375-1022
US

IV. Provider business mailing address

55 WESTCHESTER SQ
BRONX NY
10461-3525
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax:
Mailing address:
  • Phone: 718-931-4045
  • Fax: 718-828-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: