Provider Demographics
NPI:1841693199
Name:HOTCHKISS, LISA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:HOTCHKISS
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:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:845-838-7038
Mailing Address - Fax:845-373-6028
Practice Address - Street 1:3360 ROUTE 343
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5619
Practice Address - Country:US
Practice Address - Phone:845-838-7038
Practice Address - Fax:845-373-6028
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087842-1104100000X
NY0847731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04598734Medicaid