Basic Information
| Provider Information | |||||||||
| NPI: | 1235447053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAXMAN GOLDFARB | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 HOLLY BERRY CT | ||||||||
| Address2: | |||||||||
| City: | WADING RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117922157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165031553 | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314760564 | ||||||||
| FaxNumber: | 6314769322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2010 | ||||||||
| LastUpdateDate: | 09/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 011631 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.