Provider Demographics
NPI:1235424821
Name:SOMMERS, ELIZABETH A (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 PRINCETON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1524
Mailing Address - Country:US
Mailing Address - Phone:607-962-3148
Mailing Address - Fax:607-962-8422
Practice Address - Street 1:280 PRINCETON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1524
Practice Address - Country:US
Practice Address - Phone:607-962-3148
Practice Address - Fax:607-962-8422
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY0827041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY082704Medicaid