Provider Demographics
NPI:1336866300
Name:LIZA MORDKOVICH COUNSELING
Entity Type:Organization
Organization Name:LIZA MORDKOVICH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE & PAYER SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-983-2615
Mailing Address - Street 1:90 STATE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1707
Mailing Address - Country:US
Mailing Address - Phone:917-983-2615
Mailing Address - Fax:866-282-0569
Practice Address - Street 1:90 STATE ST STE 700
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1707
Practice Address - Country:US
Practice Address - Phone:917-983-2615
Practice Address - Fax:866-282-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty