Provider Demographics
NPI:1558199497
Name:BERNSTEIN, LISA (LMSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 W 17TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5445
Mailing Address - Country:US
Mailing Address - Phone:610-592-4993
Mailing Address - Fax:
Practice Address - Street 1:4308 52ND ST FL 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3256
Practice Address - Country:US
Practice Address - Phone:610-592-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123677104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker