Provider Demographics
NPI:1346593217
Name:BIZZOCO-FRAATZ, GINA MARIE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:BIZZOCO-FRAATZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:BIZZOCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 SOUTH RD STE 44-273
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-7003
Mailing Address - Country:US
Mailing Address - Phone:518-444-0181
Mailing Address - Fax:
Practice Address - Street 1:2600 SOUTH RD STE 44-273
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-7003
Practice Address - Country:US
Practice Address - Phone:518-444-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084342104100000X
NY0823811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker