Provider Demographics
NPI:1376062356
Name:CENTRONE, LISA ANN (MSED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CENTRONE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 VLEIGH PL
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3360
Mailing Address - Country:US
Mailing Address - Phone:718-591-9093
Mailing Address - Fax:718-591-9499
Practice Address - Street 1:7740 VLEIGH PL
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-3360
Practice Address - Country:US
Practice Address - Phone:718-591-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool