Provider Demographics
NPI:1134483720
Name:WALDMAN, LISA (M ED SP EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:M ED SP EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD STE 380
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3518
Mailing Address - Country:US
Mailing Address - Phone:585-223-5090
Mailing Address - Fax:585-425-1785
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD STE 380
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3518
Practice Address - Country:US
Practice Address - Phone:585-223-5090
Practice Address - Fax:585-425-1785
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist