Provider Demographics
NPI:1336353002
Name:MCLOUGHLIN, LISA LANE (MS, LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LANE
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WHITEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1137
Mailing Address - Country:US
Mailing Address - Phone:914-403-8559
Mailing Address - Fax:914-592-0123
Practice Address - Street 1:26 WHITEWOOD RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1137
Practice Address - Country:US
Practice Address - Phone:914-403-8559
Practice Address - Fax:914-592-0123
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003051-01171100000X
CT000347171100000X
PAAK000816171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist