Provider Demographics
NPI:1568257814
Name:SEVILLANO, LISA MAKSIMYADIS
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MAKSIMYADIS
Last Name:SEVILLANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MAKSIMYADIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18 PINES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4112
Mailing Address - Country:US
Mailing Address - Phone:914-552-5657
Mailing Address - Fax:
Practice Address - Street 1:1983 CROMPOND RD STE 203
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4121
Practice Address - Country:US
Practice Address - Phone:914-552-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health