Provider Demographics
NPI:1225346943
Name:MCVEY, LISA O (LICENSE)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:O
Last Name:MCVEY
Suffix:
Gender:F
Credentials:LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 W TAFT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2767
Mailing Address - Country:US
Mailing Address - Phone:315-247-3376
Mailing Address - Fax:
Practice Address - Street 1:5355 W TAFT RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2767
Practice Address - Country:US
Practice Address - Phone:315-247-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008310-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist