Provider Demographics
NPI:1750058111
Name:COOTS, LILY ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:ELIZABETH
Last Name:COOTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2405
Mailing Address - Country:US
Mailing Address - Phone:315-591-2236
Mailing Address - Fax:
Practice Address - Street 1:3358 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3002
Practice Address - Country:US
Practice Address - Phone:315-963-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113657-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker