Provider Demographics
NPI:1851924518
Name:MANNINO, LISA A (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:MANNINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GREEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4503
Mailing Address - Country:US
Mailing Address - Phone:845-527-8543
Mailing Address - Fax:
Practice Address - Street 1:21 GREEN ST APT 2
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4503
Practice Address - Country:US
Practice Address - Phone:845-527-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health