Provider Demographics
NPI:1205840600
Name:VERGOZ, ELIZABETH E (PH D)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:VERGOZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:E
Other - Last Name:VERGOZ-REKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PH D
Mailing Address - Street 1:65 N MAPLE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3233
Mailing Address - Country:US
Mailing Address - Phone:201-655-5434
Mailing Address - Fax:
Practice Address - Street 1:65 N MAPLE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3233
Practice Address - Country:US
Practice Address - Phone:201-655-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117161103T00000X
NJ4253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist