Healthcare Provider Details

I. General information

NPI: 1801354311
Provider Name (Legal Business Name): LISA ARDOVINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 HEMLOCK DR
WEST SENECA NY
14224-4208
US

IV. Provider business mailing address

96 HEMLOCK DR
WEST SENECA NY
14224-4208
US

V. Phone/Fax

Practice location:
  • Phone: 716-393-9866
  • Fax:
Mailing address:
  • Phone: 716-393-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008786-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: