Provider Demographics
NPI:1417018235
Name:LITT, LISA CAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CAREN
Last Name:LITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W 108TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2913
Mailing Address - Country:US
Mailing Address - Phone:212-252-2928
Mailing Address - Fax:212-253-2140
Practice Address - Street 1:411 W 114TH ST # 3B
Practice Address - Street 2:ST. LUKE'S-ROOSEVELT HOSPITAL CENTER, WHP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1710
Practice Address - Country:US
Practice Address - Phone:212-523-2990
Practice Address - Fax:212-523-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01891592Medicaid
NYV93651Medicare ID - Type Unspecified