Provider Demographics
NPI:1164830980
Name:ABBADESSA, LISA (BA, MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ABBADESSA
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CIMINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA MS
Mailing Address - Street 1:333 WESTCHESTER AVE
Mailing Address - Street 2:WEST SUITE 202
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2910
Mailing Address - Country:US
Mailing Address - Phone:914-328-2868
Mailing Address - Fax:914-328-2973
Practice Address - Street 1:333 WESTCHESTER AVE
Practice Address - Street 2:WEST SUITE 202
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2910
Practice Address - Country:US
Practice Address - Phone:914-328-2868
Practice Address - Fax:914-328-2973
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1283598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1283598OtherSPECIAL EDUCATION CERTIFICATE STUDENTS WITH DISABILITIES GRADES 1-6
NY1283598OtherCHILDHOOD EDUCATION CERTIFICATION GRADES 1-6