Provider Demographics
NPI:1881001998
Name:NASOFF, LISA M (BCBA, MSED)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:M
Last Name:NASOFF
Suffix:
Gender:F
Credentials:BCBA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CLINTON AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4005
Mailing Address - Country:US
Mailing Address - Phone:516-712-5810
Mailing Address - Fax:
Practice Address - Street 1:37 CLINTON AVE APT 2E
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4005
Practice Address - Country:US
Practice Address - Phone:516-712-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2524103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst