Provider Demographics
NPI:1164083259
Name:SMITH, MONA LISA (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:LISA
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 MULHOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13042-3206
Mailing Address - Country:US
Mailing Address - Phone:315-709-2980
Mailing Address - Fax:
Practice Address - Street 1:1692 MULHOLLAND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NY
Practice Address - Zip Code:13042-3206
Practice Address - Country:US
Practice Address - Phone:315-709-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406714363LP0808X
NY344575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health