Provider Demographics
NPI:1811335219
Name:NOONAN, LISA S (MSED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:NOONAN
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 1:12 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4832
Mailing Address - Country:US
Mailing Address - Phone:516-921-1020
Mailing Address - Fax:516-921-1020
Practice Address - Street 1:12 LOCUST LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4832
Practice Address - Country:US
Practice Address - Phone:516-921-1020
Practice Address - Fax:516-921-1020
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency