Provider Demographics
NPI:1770661654
Name:MAYER, ELIZABETH R (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:R
Last Name:MAYER
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Gender:F
Credentials:LCSW MSW
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Mailing Address - Street 1:4555 HENRY HUDSON PARKWAY
Mailing Address - Street 2:APT 1410
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:646-474-7169
Mailing Address - Fax:718-796-0715
Practice Address - Street 1:3736 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1502
Practice Address - Country:US
Practice Address - Phone:718-543-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-10-17
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Provider Licenses
StateLicense IDTaxonomies
NY047952R103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213592357OtherUBH
NY739440OtherAETNA
NYP738265Medicare UPIN