Individual
DR. LISA E BOMSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9 PINE RD, SYOSSET, NY 11791-4217
(516) 921-2721
Mailing address
9 PINE RD, SYOSSET, NY 11791-4217
(516) 921-2721
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011728
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01590409
—
NY
Enumeration date
09/23/2006
Last updated
07/08/2007
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