Basic Information
| Provider Information | |||||||||
| NPI: | 1043417470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARLMAN | ||||||||
| FirstName: | LISSA | ||||||||
| MiddleName: | FAYE | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63 E 9TH ST APT 10R | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100036335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466493513 | ||||||||
| FaxNumber: | 6466493513 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 FLATBUSH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112172812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186222000 | ||||||||
| FaxNumber: | 7183983328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.