=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639859895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISABETH CONTI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2023
-----------------------------------------------------
Last Update Date | 07/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 ALDEN PL
-----------------------------------------------------
City | MILLBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12545-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-677-4210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 W WIND RD
-----------------------------------------------------
City | PAWLING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12564-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-729-3302
-----------------------------------------------------
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 | 117771-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------