Provider Demographics
NPI:1063726958
Name:PEDREIRA, LISETTE (MSED)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:
Last Name:PEDREIRA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CONSELYEA ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2516
Mailing Address - Country:US
Mailing Address - Phone:718-782-1462
Mailing Address - Fax:718-782-8044
Practice Address - Street 1:201 CONSELYEA ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2516
Practice Address - Country:US
Practice Address - Phone:718-782-1462
Practice Address - Fax:718-782-8044
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1914866103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool