Healthcare Provider Details

I. General information

NPI: 1225475148
Provider Name (Legal Business Name): LISA D LINDSEY LCAT ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 06/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18230 WEXFORD TER 3GG
JAMAICA NY
11432-3141
US

IV. Provider business mailing address

18230 WEXFORD TER 3GG
JAMAICA NY
11432-3141
US

V. Phone/Fax

Practice location:
  • Phone: 516-707-3173
  • Fax:
Mailing address:
  • Phone: 516-707-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: