Provider Demographics
NPI:1316038508
Name:FLACHS, LISA A (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:FLACHS
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 1:26 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2616
Mailing Address - Country:US
Mailing Address - Phone:607-432-0879
Mailing Address - Fax:
Practice Address - Street 1:25 ELM ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1959
Practice Address - Country:US
Practice Address - Phone:607-433-0774
Practice Address - Fax:607-433-0774
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034369-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1864Medicare ID - Type Unspecified
NYS35931Medicare UPIN