Individual
LISA GERSONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 SW CALIFORNIA BLVD, PORT SAINT LUCIE, FL 34953-1164
(860) 808-6693
Mailing address
1801 SW CALIFORNIA BLVD, PORT SAINT LUCIE, FL 34953-1164
(860) 808-6693
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8817
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538356787
MEDICARE
FL
Enumeration date
10/02/2007
Last updated
10/17/2014
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