Provider Demographics
NPI:1316254527
Name:MONE, LISA MICHELE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELE
Last Name:MONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PINEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-499-1237
Mailing Address - Fax:
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 152
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3012
Practice Address - Country:US
Practice Address - Phone:631-669-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY756228994235Z00000X
NY021059235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist