1467667386 NPI number — MISS LISA GALE SHOLAR LMSW, CSSW

Table of content: MISS LISA GALE SHOLAR LMSW, CSSW (NPI 1467667386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467667386 NPI number — MISS LISA GALE SHOLAR LMSW, CSSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOLAR
Provider First Name:
LISA
Provider Middle Name:
GALE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMSW, CSSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467667386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 HICKS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC GRAW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13101-9500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-745-9338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045-6606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-753-3798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  075109 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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