Provider Demographics
NPI:1700143526
Name:COLE, LISA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:COLE
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 1:30 BENNER RD
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1543
Mailing Address - Country:US
Mailing Address - Phone:845-745-0241
Mailing Address - Fax:845-758-5746
Practice Address - Street 1:30 BENNER RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1543
Practice Address - Country:US
Practice Address - Phone:845-745-0241
Practice Address - Fax:845-758-5746
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2018-03-14
Deactivation Date:2018-02-27
Deactivation Code:
Reactivation Date:2018-03-14
Provider Licenses
StateLicense IDTaxonomies
NY057730-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical