Provider Demographics
NPI:1912523929
Name:LISA FOGEL LCSW PLLC
Entity Type:Organization
Organization Name:LISA FOGEL LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-474-0356
Mailing Address - Street 1:5 FALCONBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1016
Mailing Address - Country:US
Mailing Address - Phone:585-474-0356
Mailing Address - Fax:585-244-8351
Practice Address - Street 1:5 FALCONBRIDGE DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1016
Practice Address - Country:US
Practice Address - Phone:585-474-0356
Practice Address - Fax:585-244-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)