Provider Demographics
NPI:1578825790
Name:PRISCILLA A. LINGARD, LCSW CASAC P.C.
Entity Type:Organization
Organization Name:PRISCILLA A. LINGARD, LCSW CASAC P.C.
Other - Org Name:CENTER FOR LEGAL AND SOCIAL EMPOWERMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CASAC
Authorized Official - Phone:631-506-2042
Mailing Address - Street 1:21 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2752
Mailing Address - Country:US
Mailing Address - Phone:631-506-2042
Mailing Address - Fax:631-657-3633
Practice Address - Street 1:21 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2752
Practice Address - Country:US
Practice Address - Phone:631-506-2042
Practice Address - Fax:631-657-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079193101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty