Provider Demographics
NPI:1912524794
Name:PITTELLI, LISA M (LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:PITTELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:VAN HEUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4565
Mailing Address - Country:US
Mailing Address - Phone:518-338-3117
Mailing Address - Fax:518-831-5944
Practice Address - Street 1:5 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4565
Practice Address - Country:US
Practice Address - Phone:518-338-3117
Practice Address - Fax:518-831-5944
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health