Provider Demographics
NPI:1720784671
Name:FLOM, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FLOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 YORK AVE APT 22C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6877
Mailing Address - Country:US
Mailing Address - Phone:917-543-4666
Mailing Address - Fax:
Practice Address - Street 1:1675 YORK AVE APT 22C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6877
Practice Address - Country:US
Practice Address - Phone:917-543-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0595501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical