| Lisa Dimitri Lcsw Pllc | |
|
755 Main St Ste 3 Oakdale NY 11769-1801 | |
| (631) 678-7170 | |
| (631) 224-8940 |
| Full Name | Lisa Dimitri Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 755 Main St Ste 3, Oakdale, New York |
| Authorized Official Name and Position | Lisa Dimitri (OWNER) |
| Authorized Official Contact | 6316787170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Dimitri Lcsw Pllc 116 Biltmore Ave Oakdale NY 11769-1157 Ph: () - | Lisa Dimitri Lcsw Pllc 755 Main St Ste 3 Oakdale NY 11769-1801 Ph: (631) 678-7170 |
| NPI Number | 1396430328 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 12/08/2023 |
| Certification Date | 12/08/2023 |
| Medicare PECOS PAC ID | 8820456452 |
|---|---|
| Medicare Enrollment ID | O20230614001083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396430328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa A. Dimitri |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124304571 PECOS PAC ID: 0648638270 Enrollment ID: I20230614001196 |
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