Provider Demographics
NPI:1225058753
Name:DOBERT, LILIANNE N (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:LILIANNE
Middle Name:N
Last Name:DOBERT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BARBER RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8646
Mailing Address - Country:US
Mailing Address - Phone:518-321-7429
Mailing Address - Fax:
Practice Address - Street 1:453 DIXON RD
Practice Address - Street 2:BLDG 3 STE 8
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1949
Practice Address - Country:US
Practice Address - Phone:518-321-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000597211041C0700X
NYR0692431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
53088OtherMVP
NF5211OtherBLUECROSS BLUESHIELD
040426031844OtherFIDELIS
NY00059721Medicaid
040426031844OtherFIDELIS
BB8957Medicare ID - Type Unspecified