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General NPI Number Information
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NPI Number | 1679451058
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Entity Type | Individual
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Provider Name | LISA M GAUDIOSO MPS, MS ED
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Gender | Female
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 125 TRUMAN PL
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City | CENTERPORT
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State | NY
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Zip | 11721-1339
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Country | US
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Telephone | 631-569-0094
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Fax |
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Provider Business Mailing Address
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Address Line | 125 TRUMAN PL
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City | CENTERPORT
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State | NY
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Zip | 11721-1339
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Country | US
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Telephone | 631-569-0094
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NY
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