Provider Demographics
NPI:1215149844
Name:CISTOLA, LAWRENCE BRIAN (LCSW-R)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BRIAN
Last Name:CISTOLA
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OLD TURNPIKE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2532
Mailing Address - Country:US
Mailing Address - Phone:845-353-1433
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2532
Practice Address - Country:US
Practice Address - Phone:845-353-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049815-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN17531Medicare ID - Type Unspecified