Healthcare Provider Details

I. General information

NPI: 1962315572
Provider Name (Legal Business Name): LIANNA AMANDA HALLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-14 PARSONS BLVD SUITE 24, 5TH FLOOR
JAMAICA NY
11432
US

IV. Provider business mailing address

161 CORNWELL AVE
VALLEY STREAM NY
11580-4737
US

V. Phone/Fax

Practice location:
  • Phone: 646-493-4007
  • Fax:
Mailing address:
  • Phone: 732-648-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: