Healthcare Provider Details

I. General information

NPI: 1437937166
Provider Name (Legal Business Name): LISSY J ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 GREENE COUNTY OFFICE BLDG
CAIRO NY
12413-2868
US

IV. Provider business mailing address

905 GREENE COUNTY OFFICE BLDG
CAIRO NY
12413-2868
US

V. Phone/Fax

Practice location:
  • Phone: 518-622-9163
  • Fax: 518-622-8592
Mailing address:
  • Phone: 518-622-9163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125417-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: