=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811271703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIZABETH SUE WAPLES LCSW - R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2011
-----------------------------------------------------
Last Update Date | 10/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 MAIN ST
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-762-8199
-----------------------------------------------------
Fax | 607-762-8134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 HICKORY RD
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-724-0339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 070371 - 1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------