Provider Demographics
NPI:1811184724
Name:GOSLAR, LISA ANN (MSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:GOSLAR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:SHOREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:138 NEW RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12547-5009
Mailing Address - Country:US
Mailing Address - Phone:845-629-7539
Mailing Address - Fax:
Practice Address - Street 1:138 NEW RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NY
Practice Address - Zip Code:12547-5009
Practice Address - Country:US
Practice Address - Phone:845-629-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker