Provider Demographics
NPI:1336446335
Name:SERRINS, LAKE (MSW)
Entity Type:Individual
Prefix:
First Name:LAKE
Middle Name:
Last Name:SERRINS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SOUTH AVE
Mailing Address - Street 2:105
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4818
Mailing Address - Country:US
Mailing Address - Phone:845-546-3330
Mailing Address - Fax:
Practice Address - Street 1:205 SOUTH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4818
Practice Address - Country:US
Practice Address - Phone:845-546-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079780-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health