Provider Demographics
NPI:1669426359
Name:WAITZMAN, ERIC DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:WAITZMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8838 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7304
Mailing Address - Country:US
Mailing Address - Phone:212-686-7500
Mailing Address - Fax:212-951-3391
Practice Address - Street 1:423 E 23RD ST
Practice Address - Street 2:NEW YORK HARBOR DEPARTMENT OF VETERAN'S AFAIRS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:212-951-3391
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071628-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical