=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912812785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMACK PSYCHOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2026
-----------------------------------------------------
Last Update Date | 08/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 554 LARKFIELD RD STE 204
-----------------------------------------------------
City | E NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11731-4205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-437-0677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 HAMLET DR
-----------------------------------------------------
City | COMMACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11725-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LISA SHAPIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-437-0677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------