Provider Demographics
NPI:1477331361
Name:CORDISCO, LINDSAY TALLO
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:TALLO
Last Name:CORDISCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 GREENGROVE DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1314
Mailing Address - Country:US
Mailing Address - Phone:315-256-1570
Mailing Address - Fax:
Practice Address - Street 1:4418 GREENGROVE DR
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1314
Practice Address - Country:US
Practice Address - Phone:315-256-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3269853103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool