Basic Information
| Provider Information | |||||||||
| NPI: | 1467410399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLIMMER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX: PSYCH | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146410001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855860240 | ||||||||
| FaxNumber: | 5852760161 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LOCKWOOD DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145343755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855860240 | ||||||||
| FaxNumber: | 5855860261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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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 | 2084P0800X | 220471 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 141939338 | 01 | NY | TAX ID | OTHER | 02165093 | 05 | NY | MEDICAID | 106837EU | 01 | NY | PREFERRED CARE | OTHER |