Provider Demographics
NPI:1104867977
Name:LACOLLA, LOURDES G (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:G
Last Name:LACOLLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 LINDALE ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2310
Mailing Address - Country:US
Mailing Address - Phone:516-785-2883
Mailing Address - Fax:516-783-7380
Practice Address - Street 1:220 PETTIT AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3629
Practice Address - Country:US
Practice Address - Phone:516-233-8758
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0519051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical