Provider Demographics
NPI:1811271703
Name:WAPLES, LIZABETH SUE (LCSW - R)
Entity type:Individual
Prefix:MRS
First Name:LIZABETH
Middle Name:SUE
Last Name:WAPLES
Suffix:
Gender:F
Credentials:LCSW - R
Other - Prefix:MRS
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:WAPLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW - R
Mailing Address - Street 1:25 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1347
Mailing Address - Country:US
Mailing Address - Phone:607-724-0339
Mailing Address - Fax:
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-3100
Practice Address - Country:US
Practice Address - Phone:607-762-8199
Practice Address - Fax:607-762-8134
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070371 - 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1025Medicaid