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General NPI Number Information
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NPI Number | 1811331689
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Entity Type | Individual
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Provider Name | LISA MARIE CARNICELLI LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 25 GREEN LINKS TURN
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City | AUBURN
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State | NY
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Zip | 13021-9673
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Country | US
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Telephone | 315-224-7042
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Fax |
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Provider Business Mailing Address
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Address Line | 25 GREEN LINKS TURN
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City | AUBURN
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State | NY
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Zip | 13021-9673
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Country | US
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Telephone | 315-224-7042
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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 | 001149-1
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License Number State | NY
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