Basic Information
| Provider Information | |||||||||
| NPI: | 1437393014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MA, NCSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 NEW YORK RD | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129033981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 NEW YORK RD | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129033981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186377345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103TS0200X | 1406035201 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.