Healthcare Provider Details

I. General information

NPI: 1134718281
Provider Name (Legal Business Name): LISSY ALCANTARA MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 FORT WASHINGTON AVE APT 1B
NEW YORK NY
10032-1316
US

IV. Provider business mailing address

286 FORT WASHINGTON AVE
NEW YORK NY
10032-1315
US

V. Phone/Fax

Practice location:
  • Phone: 212-927-0300
  • Fax: 347-230-8844
Mailing address:
  • Phone: 212-927-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number299636395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: