Provider Demographics
NPI:1821655309
Name:SERGI, ELIZABETH M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:SERGI
Suffix:
Gender:F
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 1:190 MINEOLA BLVD APT 1F
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2537
Mailing Address - Country:US
Mailing Address - Phone:516-581-0644
Mailing Address - Fax:
Practice Address - Street 1:265 POST AVE STE 116
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2235
Practice Address - Country:US
Practice Address - Phone:516-581-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0838371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical