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General NPI Number Information
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NPI Number | 1558845206
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Entity Type | Organization
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Legal Business Name | LMI PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 105 GROVE ST STE 14-3
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4051
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Country | US
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Telephone | 503-307-0754
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Fax |
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Provider Business Mailing Address
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Address Line | 80 GROVE ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA M ILARIA
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Credential | PSYD
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Telephone | 973-983-3762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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