Individual
LISA HENDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 FORTUNE RD W, MIDDLETOWN, NY 10941-1625
(845) 692-4454
Mailing address
15 FORTUNE RD W, SCOTCHTOWN, NY 10941-1625
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
083094-1
NY
Other
Enumeration date
09/30/2016
Last updated
03/22/2017
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