Provider Demographics
NPI:1508032079
Name:ST. MARY'S HOSPITAL
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:PEPPER
Authorized Official - Last Name:LISIESKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:518-884-0713
Mailing Address - Street 1:234 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1935
Mailing Address - Country:US
Mailing Address - Phone:518-775-5723
Mailing Address - Fax:
Practice Address - Street 1:234 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1935
Practice Address - Country:US
Practice Address - Phone:518-775-5723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO39923-1284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital