Provider Demographics
NPI:1114030921
Name:PUGLIESE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 WELLINGTON GREEN DR
Mailing Address - Street 2:#205
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2325 WELLINGTON GREEN DRIVE
Practice Address - Street 2:#205
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9315
Practice Address - Country:US
Practice Address - Phone:561-351-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist