Provider Demographics
NPI:1356606404
Name:LINEHAN, LISA FOURNIER (MSED)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:FOURNIER
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1200
Mailing Address - Country:US
Mailing Address - Phone:607-687-8929
Mailing Address - Fax:607-687-8153
Practice Address - Street 1:1277 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1200
Practice Address - Country:US
Practice Address - Phone:607-687-8929
Practice Address - Fax:607-687-8153
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist