Provider Demographics
NPI:1780631341
Name:ZAWALSKI, LISA (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZAWALSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2402
Mailing Address - Country:US
Mailing Address - Phone:207-812-2761
Mailing Address - Fax:
Practice Address - Street 1:1 PINNACLE PLACE SUITE 102
Practice Address - Street 2:PINNACLE BEHAVIORAL HEALTH
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3001
Practice Address - Country:US
Practice Address - Phone:518-689-0244
Practice Address - Fax:518-689-0241
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81195363LP0808X
NYF400743-1363LP0808X
MARN2297629363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432184599OtherMAINECARE NUMBER