Provider Demographics
NPI:1679200810
Name:WENDOLOSKI, ELIZABETH D (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:WENDOLOSKI
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 BARRY RD APT B
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1155
Mailing Address - Country:US
Mailing Address - Phone:845-859-0155
Mailing Address - Fax:
Practice Address - Street 1:216 BARRY RD APT B
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1155
Practice Address - Country:US
Practice Address - Phone:845-859-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110726-01104100000X
COCSW.099266921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker