Provider Demographics
NPI:1124035852
Name:MERGENTIME, LOIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:MERGENTIME
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 1:272 PIERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4663
Mailing Address - Country:US
Mailing Address - Phone:845-353-0890
Mailing Address - Fax:845-267-2173
Practice Address - Street 1:271 S BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4636
Practice Address - Country:US
Practice Address - Phone:845-641-9595
Practice Address - Fax:845-267-2173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR024991-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical