Provider Demographics
NPI:1003043407
Name:LEBRON, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3902 111TH ST
Mailing Address - Street 2:APT# R1D
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2647
Mailing Address - Country:US
Mailing Address - Phone:718-478-2629
Mailing Address - Fax:
Practice Address - Street 1:3902 111TH ST
Practice Address - Street 2:APT# R1D
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2647
Practice Address - Country:US
Practice Address - Phone:718-478-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO58795-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical