Individual
DR. LISA MICHELLE SUPINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
6 THORNDAL CIRCLE, DARIEN, CT 06820
(858) 254-4302
Mailing address
138 B OLD MOUNT KISCO RD, ARMONK, NY 10504
(858) 254-4302
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
002888
CT
103TC0700X
Clinical Psychologist
017490-1
NY
Other
Enumeration date
10/09/2008
Last updated
10/09/2008
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