Provider Demographics
NPI:1992014336
Name:YACOVONE, LISA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:YACOVONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 TIMBERPOINT RD
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3322
Mailing Address - Country:US
Mailing Address - Phone:631-581-1887
Mailing Address - Fax:
Practice Address - Street 1:200 TIMBERPOINT RD
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3322
Practice Address - Country:US
Practice Address - Phone:631-581-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 1041S0200X
NY0697001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool