Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 016851 | NY |
Y | 103TC0700X | Clinical Psychologist | 016851 | NY |
NPI | 1013071786 |
---|---|
Provider Name | Dr. Lisa Ann Foresto |
First Address | East Norwich, NY 11732 |
Second Address | Manhasset, NY 11030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00246075 | (05) | NY |