Individual
CARISSA LYNN LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS ED
Contact information
Practice address
2247 13TH ST, TROY, NY 12180-3017
(518) 273-1586
Mailing address
5 LATHAM RD, CASTLETON, NY 12033-1103
(518) 269-2705
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
484706101
NY
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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