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NPI Code Detail

MEDICARE: MRS. LILYAN ELIZABETH SPOOL LCSW, BCD

MEDICARE: MRS. LILYAN ELIZABETH SPOOL LCSW, BCD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1174543219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LILYAN ELIZABETH SPOOL LCSW, BCD
Provider Business Mailing Address
First Line : 106 VINEYARD AVE
Second Line :
City : HIGHLAND
State : NY
Zip : 12528-1422
Country : US
Telephone Number : 845-691-9191
Fax Number : 845-691-9339
Provider Business Practice Location Address
First Line : 106 VINEYARD AVE
Second Line :
City : HIGHLAND
State : NY
Zip : 12528-1422
Country : US
Telephone Number : 845-691-9191
Fax Number : 845-691-9339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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