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NPI Code Detail

MEDICARE: MRS. LISETTE SOSA-DICKSON LCSW

MEDICARE: MRS. LISETTE SOSA-DICKSON LCSW
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
11041C0700XClinical Social Worker074820NY

General Provider Information

NPI Number : 1740201094
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISETTE SOSA-DICKSON LCSW
Provider Business Mailing Address
First Line : 30 COLUMBIA PL APT 19A
Second Line :
City : BROOKLYN
State : NY
Zip : 11201-4596
Country : US
Telephone Number : 718-222-1518
Fax Number : 718-222-4376
Provider Business Practice Location Address
First Line : 10 HANOVER PL PH
Second Line :
City : BROOKLYN
State : NY
Zip : 11201-5840
Country : US
Telephone Number : 718-222-1518
Fax Number : 718-222-4376
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LISETTE SOSA-DICKSON LCSW” Practice Location

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