Provider Demographics
NPI:1588824429
Name:LUSTERMAN, ELIEZER REUVEN (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:ELIEZER
Middle Name:REUVEN
Last Name:LUSTERMAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ATLANTIC AVE
Mailing Address - Street 2:COTTAGE A
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1519
Mailing Address - Country:US
Mailing Address - Phone:516-359-8738
Mailing Address - Fax:
Practice Address - Street 1:570 ATLANTIC AVE
Practice Address - Street 2:COTTAGE A
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1519
Practice Address - Country:US
Practice Address - Phone:516-359-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041481-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical