Provider Demographics
NPI:1902152416
Name:RUCHLAMER, LISA N (MS,ED)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:N
Last Name:RUCHLAMER
Suffix:
Gender:F
Credentials:MS,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 57TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4521
Mailing Address - Country:US
Mailing Address - Phone:718-438-4993
Mailing Address - Fax:
Practice Address - Street 1:1146 57TH ST
Practice Address - Street 2:1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4521
Practice Address - Country:US
Practice Address - Phone:718-438-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0982103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst