Lisa M Davis

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

006836 Issued in NY

Practice address

22 Depot St
St Lawrence Co Nysarc Potsdam Day Habilitation
Potsdam, NY 13676

Phone

(315) 268-1003

Fax

(315) 268-0908

NPI assigned

Nov 8, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  Medicare reassignment
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • West Seneca, NY
  • NPI 1528109188
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306916564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 DEPOT ST",
            "address_2": "ST LAWRENCE CO NYSARC POTSDAM DAY HABILITATION",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-268-1003",
            "fax_number": "315-268-0908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 DEPOT ST",
            "address_2": "ST LAWRENCE CO NYSARC POTSDAM DAY HABILITATION",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-268-1003",
            "fax_number": "315-268-0908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "006836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucas Da Matta, MD
• Kamrie Dandrow, LPN
• Mary-Elizabeth Darrow, RPH
• David M. Hurlbut DDS PLLC
• David McCall MD PC
• Pota John Davis
• Brooke Ann Marie Decelles, MS, RD, CDN
• Miranda Lee Deleel, L.P.N.
• Margrethe Frank Demers, MHC
• Jackalyn Despaw

• Speech-Language Pathologist in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.