Provider Demographics
NPI:1417416165
Name:LYSS, YISROEL MORDECHAI (LMFT, LCMFT)
Entity Type:Individual
Prefix:
First Name:YISROEL
Middle Name:MORDECHAI
Last Name:LYSS
Suffix:
Gender:M
Credentials:LMFT, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 AVALON CIR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1105
Mailing Address - Country:US
Mailing Address - Phone:443-386-3636
Mailing Address - Fax:
Practice Address - Street 1:211 SCHRAFFTS DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3287
Practice Address - Country:US
Practice Address - Phone:203-518-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101Y00000X, 101YP2500X
MDLCM987106H00000X
CT002588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional