Provider Demographics
NPI:1962776427
Name:CREIGHTON, LOIS ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ANNE
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TOBIN DR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1126
Mailing Address - Country:US
Mailing Address - Phone:607-423-4323
Mailing Address - Fax:607-758-4179
Practice Address - Street 1:6 TOBIN DR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1126
Practice Address - Country:US
Practice Address - Phone:607-423-4323
Practice Address - Fax:607-758-4179
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049466-11041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool