Healthcare Provider Details

I. General information

NPI: 1235597998
Provider Name (Legal Business Name): LAURIE SOBLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 N BROADWAY
NYACK NY
10960-1522
US

IV. Provider business mailing address

339 N BROADWAY
NYACK NY
10960-1522
US

V. Phone/Fax

Practice location:
  • Phone: 845-358-7772
  • Fax: 845-353-2593
Mailing address:
  • Phone: 845-358-7772
  • Fax: 845-353-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73075630
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: