Provider Demographics
NPI:1720447550
Name:GISMONDI, MICHAEL (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GISMONDI
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FAIRLAWN DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1290
Mailing Address - Country:US
Mailing Address - Phone:845-551-6472
Mailing Address - Fax:
Practice Address - Street 1:5 FAIRLAWN DR STE 301
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1290
Practice Address - Country:US
Practice Address - Phone:845-551-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004075-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health