Provider Demographics
NPI:1447675632
Name:BURGIO, LISA M (LMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BURGIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:FRONCKOWIAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:819 S HUTH RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1722
Mailing Address - Country:US
Mailing Address - Phone:716-445-6095
Mailing Address - Fax:
Practice Address - Street 1:6265 SHERIDAN DR
Practice Address - Street 2:SUITE 122
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4833
Practice Address - Country:US
Practice Address - Phone:716-204-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health