Provider Demographics
NPI:1740512573
Name:DELLICARPINI, LISA A
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:DELLICARPINI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:DELLICARPINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:231 EAST 88TH ST
Mailing Address - Street 2:1W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3365
Mailing Address - Country:US
Mailing Address - Phone:917-375-4317
Mailing Address - Fax:
Practice Address - Street 1:231 EAST 88TH ST
Practice Address - Street 2:1W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3365
Practice Address - Country:US
Practice Address - Phone:917-375-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013356-1103K00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VL3941Medicare Oscar/Certification