Basic Information
| Provider Information | |||||||||
| NPI: | 1699833186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISMAIL | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | SARAH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.I.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72 EAST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013609644 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 78 POMEROY TER | ||||||||
| Address2: | CUTCHINS PROGRAMS, NCCF | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135841310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 111491 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.