Provider Demographics
NPI:1902975196
Name:REDDAN, LISA I (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:I
Last Name:REDDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1147
Mailing Address - Country:US
Mailing Address - Phone:516-437-6050
Mailing Address - Fax:516-437-6304
Practice Address - Street 1:510 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1147
Practice Address - Country:US
Practice Address - Phone:516-437-6050
Practice Address - Fax:516-437-6304
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0771841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666971Medicaid