Provider Demographics
NPI:1316194160
Name:SOMECK, LISA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SOMECK
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 1:20 CANTERBURY RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2122
Mailing Address - Country:US
Mailing Address - Phone:516-304-5354
Mailing Address - Fax:
Practice Address - Street 1:20 CANTERBURY RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2122
Practice Address - Country:US
Practice Address - Phone:516-304-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041081-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N1U321Medicare PIN