Provider Demographics
NPI:1194846493
Name:LINGARD, PRISCILLA A (CASAC-T)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:LINGARD
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-0031
Mailing Address - Country:US
Mailing Address - Phone:631-723-3362
Mailing Address - Fax:
Practice Address - Street 1:31 E MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-1816
Practice Address - Country:US
Practice Address - Phone:631-723-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02249145Medicare ID - Type Unspecified