Provider Demographics
NPI:1629143847
Name:LISANTI, ROBIN LEE (LCSWR)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:LISANTI
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1614
Mailing Address - Country:US
Mailing Address - Phone:631-473-2855
Mailing Address - Fax:
Practice Address - Street 1:4577 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2626
Practice Address - Country:US
Practice Address - Phone:631-473-2855
Practice Address - Fax:631-473-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049505-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical