Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | R074292-1 | NY |
Y | 101YS0200X | School Counselor | 074292-1 | NY |
NPI | 1124304571 |
---|---|
Provider Name | Lisa A. Dimitri |
First Address | Oakdale, NY 11769-1157 |
Second Address | Sayville, NY 11782-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 17/08/2016 |