Provider Demographics
NPI:1538489646
Name:DEVINCENTIS, LISA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:DEVINCENTIS
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 1:321 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-2427
Mailing Address - Country:US
Mailing Address - Phone:607-723-1007
Mailing Address - Fax:
Practice Address - Street 1:999 TAFT AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-7205
Practice Address - Country:US
Practice Address - Phone:607-757-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011308-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist