Provider Demographics
NPI:1861825564
Name:BIRNBAUM, LISA ROBYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ROBYN
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COOPER ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3819
Mailing Address - Country:US
Mailing Address - Phone:516-398-8762
Mailing Address - Fax:
Practice Address - Street 1:29 COOPER ST APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3819
Practice Address - Country:US
Practice Address - Phone:516-398-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker