Provider Demographics
NPI:1891071858
Name:IERACI, LISA MARIA (MA, LCAT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIA
Last Name:IERACI
Suffix:
Gender:F
Credentials:MA, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195-06A 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-423-6200
Mailing Address - Fax:
Practice Address - Street 1:243-02 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-423-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000069-1102X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist