Provider Demographics
NPI:1699970483
Name:FOGEL, LISA REBECCA (MSW)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:REBECCA
Last Name:FOGEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 E END
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1006
Mailing Address - Country:US
Mailing Address - Phone:516-295-3050
Mailing Address - Fax:516-295-7858
Practice Address - Street 1:7150 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-4131
Practice Address - Country:US
Practice Address - Phone:718-591-6750
Practice Address - Fax:718-591-4397
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical