Healthcare Provider Details

I. General information

NPI: 1235914953
Provider Name (Legal Business Name): LISA LIVERMORE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FRANKLIN AVE
LYNBROOK NY
11563-1264
US

IV. Provider business mailing address

31 FAIRMOUNT ST
HUNTINGTON NY
11743-3501
US

V. Phone/Fax

Practice location:
  • Phone: 516-218-2545
  • Fax:
Mailing address:
  • Phone: 516-987-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: