Provider Demographics
NPI:1265751382
Name:BRIGGS-BOLLING, IZETTA (DSW, LCSW, LMHC, CAS)
Entity type:Individual
Prefix:DR
First Name:IZETTA
Middle Name:
Last Name:BRIGGS-BOLLING
Suffix:
Gender:
Credentials:DSW, LCSW, LMHC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4274
Mailing Address - Country:US
Mailing Address - Phone:845-313-4496
Mailing Address - Fax:
Practice Address - Street 1:2462 ROUTE 302
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-3230
Practice Address - Country:US
Practice Address - Phone:845-313-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087722104100000X
NY003343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health