Provider Demographics
NPI:1851557540
Name:CANNIFF, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CANNIFF
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 1:20 HOSPITAL RD
Mailing Address - Street 2:322 CEDARWOOD HALL
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1538
Mailing Address - Country:US
Mailing Address - Phone:914-493-5982
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL RD
Practice Address - Street 2:322 CEDARWOOD HALL
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1538
Practice Address - Country:US
Practice Address - Phone:914-493-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018295-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018295-1OtherNY STATE LICENSE