Provider Demographics
NPI:1376259986
Name:DAVERSA, LINDSAY (LMSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:DAVERSA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:HINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2646 SWART HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-9077
Mailing Address - Country:US
Mailing Address - Phone:607-287-4670
Mailing Address - Fax:
Practice Address - Street 1:2646 SWART HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-9077
Practice Address - Country:US
Practice Address - Phone:607-287-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health