Provider Demographics
NPI:1861967036
Name:INFANTE, LISA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:INFANTE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUNNYBROOK RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-5430
Mailing Address - Country:US
Mailing Address - Phone:917-557-2320
Mailing Address - Fax:
Practice Address - Street 1:127 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1461
Practice Address - Country:US
Practice Address - Phone:914-488-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027949-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist