Provider Demographics
NPI:1629571393
Name:MCARDLE, LISA ANN (MS ED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BRENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1314
Mailing Address - Country:US
Mailing Address - Phone:516-729-7231
Mailing Address - Fax:
Practice Address - Street 1:41 HARVARD ST
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1314
Practice Address - Country:US
Practice Address - Phone:516-729-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist