Provider Demographics
NPI:1164640827
Name:LEMON, DESPINA TINA (LMSW)
Entity Type:Individual
Prefix:
First Name:DESPINA
Middle Name:TINA
Last Name:LEMON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WASHINGTON ST
Mailing Address - Street 2:APRT.#3
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1611
Mailing Address - Country:US
Mailing Address - Phone:315-394-0101
Mailing Address - Fax:315-394-0097
Practice Address - Street 1:109 FORD ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1419
Practice Address - Country:US
Practice Address - Phone:315-394-0101
Practice Address - Fax:315-394-0097
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070776104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker