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General NPI Number Information
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NPI Number | 1003966623
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Entity Type | Individual
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Provider Name | LISA CLAIRE PELTON LCSWR
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 280 N BEDFORD RD STE 203
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City | MOUNT KISCO
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State | NY
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Zip | 10549-1147
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Country | US
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Telephone | 914-523-6852
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Fax |
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Provider Business Mailing Address
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Address Line | 19 STANWOOD RD
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City | MOUNT KISCO
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State | NY
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Zip | 10549-4206
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Country | US
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Telephone | 914-962-5593
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Fax | 914-962-5599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R049256-1
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License Number State | NY
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