Provider Demographics
NPI:1356603286
Name:BUTERA-SGOUROS, LISA MARIE (MS-SPECIAL EDUCATION)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BUTERA-SGOUROS
Suffix:
Gender:F
Credentials:MS-SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1536
Mailing Address - Country:US
Mailing Address - Phone:516-298-4840
Mailing Address - Fax:516-371-4840
Practice Address - Street 1:1706 PARK ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509-1536
Practice Address - Country:US
Practice Address - Phone:516-298-4840
Practice Address - Fax:516-371-4840
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist