Provider Demographics
NPI:1487997375
Name:BLUMENFELD LA FATA, LISA (MSED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BLUMENFELD LA FATA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BLUMENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:2950 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1383
Mailing Address - Country:US
Mailing Address - Phone:516-796-0989
Mailing Address - Fax:516-731-0813
Practice Address - Street 1:2950 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1383
Practice Address - Country:US
Practice Address - Phone:516-796-0989
Practice Address - Fax:516-731-0813
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst