Provider Demographics
NPI:1417077926
Name:LISS, LORRI P (MS CCC)
Entity Type:Individual
Prefix:MS
First Name:LORRI
Middle Name:P
Last Name:LISS
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 VIVIAN DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6522
Mailing Address - Country:US
Mailing Address - Phone:914-725-6019
Mailing Address - Fax:914-725-6019
Practice Address - Street 1:28 VIVIAN DR
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-6522
Practice Address - Country:US
Practice Address - Phone:914-725-6019
Practice Address - Fax:914-725-6019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003967-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist