Provider Demographics
NPI:1922598804
Name:ZEIGLER, ELIZABETH HEATHER (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HEATHER
Last Name:ZEIGLER
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:HEATHER
Other - Last Name:GEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6550
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6550
Mailing Address - Country:US
Mailing Address - Phone:315-782-7445
Mailing Address - Fax:315-779-1184
Practice Address - Street 1:211 J.B. WISE PLAZA
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-7445
Practice Address - Fax:315-779-1184
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106371104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3372621Medicaid