Provider Demographics
NPI:1841553633
Name:CANTWELL, LISA LYNN (MS ED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:HOFSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:300 CORPORATE BLVD S
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6862
Mailing Address - Country:US
Mailing Address - Phone:914-294-6158
Mailing Address - Fax:914-294-6179
Practice Address - Street 1:300 CORPORATE BLVD S
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6862
Practice Address - Country:US
Practice Address - Phone:914-294-6158
Practice Address - Fax:914-294-6179
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist