Individual
LISA A MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 LOMOND CT, UTICA, NY 13502-5951
(315) 724-4286
(315) 724-4170
Mailing address
130 LOMOND CT, UTICA, NY 13502-5951
(315) 724-4286
(315) 724-4170
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2185967
NY
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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