Provider Demographics
NPI:1740201094
Name:SOSA-DICKSON, LISETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISETTE
Middle Name:
Last Name:SOSA-DICKSON
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 1:30 COLUMBIA PL APT 19A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4596
Mailing Address - Country:US
Mailing Address - Phone:718-222-1518
Mailing Address - Fax:718-222-4376
Practice Address - Street 1:10 HANOVER PL PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5840
Practice Address - Country:US
Practice Address - Phone:718-222-1518
Practice Address - Fax:718-222-4376
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical