Provider Demographics
NPI:1437457835
Name:ULANOFF, LISA M (LLMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ULANOFF
Suffix:
Gender:F
Credentials:LLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 ROCKAWAY PARKWAY
Mailing Address - Street 2:ASTRO CARE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2339
Mailing Address - Country:US
Mailing Address - Phone:718-257-3400
Mailing Address - Fax:
Practice Address - Street 1:1310 ROCKAWAY PARKWAY
Practice Address - Street 2:ASTRO CARE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2339
Practice Address - Country:US
Practice Address - Phone:718-257-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP78428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health