Provider Demographics
NPI:1497988398
Name:FOSS, LILLIAN JANET (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:JANET
Last Name:FOSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-2117
Mailing Address - Country:US
Mailing Address - Phone:631-765-8930
Mailing Address - Fax:
Practice Address - Street 1:135 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-2117
Practice Address - Country:US
Practice Address - Phone:631-765-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0767891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical