Provider Demographics
NPI:1073020467
Name:GDOVIN, ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GDOVIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1601
Practice Address - Country:US
Practice Address - Phone:607-563-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0915151041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01398892Medicaid