Provider Demographics
NPI:1003966623
Name:PELTON, LISA CLAIRE (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CLAIRE
Last Name:PELTON
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STANWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4206
Mailing Address - Country:US
Mailing Address - Phone:914-962-5593
Mailing Address - Fax:914-962-5599
Practice Address - Street 1:280 N BEDFORD RD STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1147
Practice Address - Country:US
Practice Address - Phone:914-523-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049256-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY140049256NY01OtherANTHEM
NY200747OtherHEALTHNET
NYND9651Medicare PIN