Healthcare Provider Details

I. General information

NPI: 1801701511
Provider Name (Legal Business Name): AMANDA R LISANTI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 N NIAGARA AVE
LINDENHURST NY
11757-3514
US

IV. Provider business mailing address

469 N NIAGARA AVE
LINDENHURST NY
11757-3514
US

V. Phone/Fax

Practice location:
  • Phone: 631-766-1795
  • Fax:
Mailing address:
  • Phone: 631-766-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: