Provider Demographics
NPI:1326454620
Name:FARLEY, LISA (CHHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:CHHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 70TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4424
Mailing Address - Country:US
Mailing Address - Phone:917-714-1970
Mailing Address - Fax:
Practice Address - Street 1:125 W 70TH ST
Practice Address - Street 2:3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4424
Practice Address - Country:US
Practice Address - Phone:917-714-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education