Provider Demographics
NPI:1407059959
Name:PODIETZ, EVA-LYNN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:EVA-LYNN
Middle Name:
Last Name:PODIETZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W 83RD ST
Mailing Address - Street 2:APARTMENT 7D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5223
Mailing Address - Country:US
Mailing Address - Phone:646-351-9176
Mailing Address - Fax:
Practice Address - Street 1:124 W FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5659
Practice Address - Country:US
Practice Address - Phone:718-367-8500
Practice Address - Fax:718-584-7109
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123353104100000X
NY0414261041C0700X
PACW0139081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical