Provider Demographics
NPI:1891499364
Name:WILHELMY, LISA NICOLE (MS, MHC-LP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:WILHELMY
Suffix:
Gender:F
Credentials:MS, MHC-LP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NICOLE
Other - Last Name:HENGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1651
Mailing Address - Country:US
Mailing Address - Phone:631-879-8154
Mailing Address - Fax:631-567-1648
Practice Address - Street 1:405 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1651
Practice Address - Country:US
Practice Address - Phone:631-868-1244
Practice Address - Fax:631-567-1648
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP14858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health