Provider Demographics
NPI:1992031066
Name:NIZEWITZ, LAURA SUE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUE
Last Name:NIZEWITZ
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 1:200 MIDWAY PARK DR
Mailing Address - Street 2:SUITE 1 WEST
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2642
Mailing Address - Country:US
Mailing Address - Phone:845-343-7274
Mailing Address - Fax:845-343-4545
Practice Address - Street 1:200 MIDWAY PARK DR
Practice Address - Street 2:SUITE 1 WEST
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2642
Practice Address - Country:US
Practice Address - Phone:845-343-7274
Practice Address - Fax:845-343-4545
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW-R0287261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical