Provider Demographics
NPI:1073878211
Name:BENCIVENGA LEE, LISA ANNE (MSSPEC ED)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:BENCIVENGA LEE
Suffix:
Gender:F
Credentials:MSSPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LORDLY CT
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3817
Mailing Address - Country:US
Mailing Address - Phone:631-269-6727
Mailing Address - Fax:
Practice Address - Street 1:9 LORDLY CT
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3817
Practice Address - Country:US
Practice Address - Phone:631-269-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1491305174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist