Provider Demographics
NPI:1326379371
Name:WILLIS, ELIZABETH ANNE (LCSWR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8808
Practice Address - Street 1:3360 ROUTE 343
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5619
Practice Address - Country:US
Practice Address - Phone:845-838-7038
Practice Address - Fax:845-373-7021
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR028655-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03221785Medicaid
NYA400076934Medicare PIN