Provider Demographics
NPI:1568837409
Name:KATZ, ELISHEVA RENA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISHEVA
Middle Name:RENA
Last Name:KATZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELISHEVA
Other - Middle Name:
Other - Last Name:UNGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 VAN HOUTEN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4602
Mailing Address - Country:US
Mailing Address - Phone:201-316-6592
Mailing Address - Fax:
Practice Address - Street 1:1 HAMASPIK WAY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-8451
Practice Address - Country:US
Practice Address - Phone:845-655-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NY022597103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022597OtherLICENSURE NUMBER
NY05237527Medicaid
NY1407211OtherUNIVERSITY OF THE STATE OF NEW YORK: EDUCATION DEPARTMENT