Provider Demographics
NPI:1407164171
Name:BABICH, LISA TAMAR (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:TAMAR
Last Name:BABICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 63RD ST
Mailing Address - Street 2:APT. 401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7466
Mailing Address - Country:US
Mailing Address - Phone:917-650-2318
Mailing Address - Fax:
Practice Address - Street 1:245 E 63RD ST
Practice Address - Street 2:APT. 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7466
Practice Address - Country:US
Practice Address - Phone:917-650-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist