Lisa A. Dimitri, LCSW
Individual provider Active NPI School Counselor · Oakdale, NY
NPI 1124304571 · NPPES record last updated Jan 22, 2024
Key facts
- NPI
- 1124304571
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Counselor 101YS0200X
- License
- 074292-1 (NY)
- Practice address
- 755 Main St Ste 3
Oakdale, NY 11769-1801 - Phone
- (631) 678-7170
- Fax
- (631) 224-8940
- NPI assigned
- Oct 31, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 6, 2025 through Oct 6, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R074292-1 | NY | MD | Mental Health Counselor |
| 074292-1 | NY | MD | School Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Shore Counseling LCSW, PLLC | Current |
Accepting new patients |
Locations
755 Montauk Hwy
Ste 3
Oakdale, NY 11769
Phone (631) 602-0079
100 S Main St
Ste 206
Sayville, NY 11782
Phone (631) 277-4080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R074292-1 | NY | |
| School Counselor | 101YS0200X | 074292-1 | NY | Yes |
Addresses
Primary practice location
755 Main St Ste 3
Oakdale, NY 11769-1801
Mailing address
116 Biltmore Ave
Oakdale, NY 11769-1157
Phone (631) 678-7170
Other providers in Oakdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.