=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467667386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA GALE SHOLAR LMSW, CSSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 07/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 MAIN ST SUITE 302
-----------------------------------------------------
City | CORTLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13045-6606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-753-3798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 HICKS HILL RD
-----------------------------------------------------
City | MC GRAW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13101-9500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-745-9338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 075109
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------