Provider Demographics
NPI:1578685830
Name:LAUDANTE, LISA M (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:LAUDANTE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1901
Mailing Address - Country:US
Mailing Address - Phone:516-770-6143
Mailing Address - Fax:
Practice Address - Street 1:500 OLD COUNTRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1901
Practice Address - Country:US
Practice Address - Phone:516-770-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0284631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical