Provider Demographics
NPI:1164170494
Name:NORDLANDER, ELIZABETH KATHRYN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHRYN
Last Name:NORDLANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6067 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5167
Mailing Address - Country:US
Mailing Address - Phone:917-833-6255
Mailing Address - Fax:
Practice Address - Street 1:87 RICHARDSON ST STE 14
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1319
Practice Address - Country:US
Practice Address - Phone:917-833-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0917441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical