Provider Demographics
NPI:1457627416
Name:FORLENZA-MARTIN, LISA M (CCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:FORLENZA-MARTIN
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ELINORE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4239
Mailing Address - Country:US
Mailing Address - Phone:516-546-8611
Mailing Address - Fax:
Practice Address - Street 1:2421 ELINORE AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4239
Practice Address - Country:US
Practice Address - Phone:516-546-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006714-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist