Provider Demographics
NPI:1326374083
Name:LEV, LISA (SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LEV
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5425
Mailing Address - Country:US
Mailing Address - Phone:718-828-9400
Mailing Address - Fax:718-409-0819
Practice Address - Street 1:1880 WATSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5425
Practice Address - Country:US
Practice Address - Phone:718-828-9400
Practice Address - Fax:718-409-0819
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0092021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist