Provider Demographics
NPI:1285003715
Name:MCCAULEY, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCCAULEY
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 1:61 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-1205
Mailing Address - Country:US
Mailing Address - Phone:315-408-2505
Mailing Address - Fax:
Practice Address - Street 1:61 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-1205
Practice Address - Country:US
Practice Address - Phone:315-408-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist