Individual
MS. LISA C BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 LAKE AVE, STATEN ISLAND, NY 10303-2629
(718) 816-3481
Mailing address
400 LAKE AVE, STATEN ISLAND, NY 10303-2629
(718) 816-3481
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
12/04/2014
Last updated
12/04/2014
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