Provider Demographics
NPI:1487051330
Name:LUSTGARTEN, LINDSAY (LCSW-R)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:LUSTGARTEN
Suffix:
Gender:F
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 1:694 TERRACE HTS
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1033
Mailing Address - Country:US
Mailing Address - Phone:516-459-2255
Mailing Address - Fax:
Practice Address - Street 1:302 5TH AVE
Practice Address - Street 2:STE 1102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3604
Practice Address - Country:US
Practice Address - Phone:516-459-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0851711041C0700X
NY0851711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical