Provider Demographics
NPI:1164608188
Name:ELIZONDO, NINO A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NINO
Middle Name:A
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CRICCHIO DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-6321
Mailing Address - Country:US
Mailing Address - Phone:703-927-6322
Mailing Address - Fax:845-236-7476
Practice Address - Street 1:45 CRICCHIO DR
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-6321
Practice Address - Country:US
Practice Address - Phone:703-927-6322
Practice Address - Fax:845-236-7476
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0722141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical