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General NPI Number Information
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NPI Number | 1568257814
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Entity Type | Individual
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Provider Name | LISA MAKSIMYADIS SEVILLANO
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Gender | Female
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 1983 CROMPOND RD STE 203
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-4121
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Country | US
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Telephone | 914-552-5657
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Fax |
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Provider Business Mailing Address
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Address Line | 18 PINES BRIDGE RD
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City | MOUNT KISCO
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State | NY
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Zip | 10549-4112
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Country | US
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Telephone | 914-552-5657
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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