Provider Demographics
NPI:1740648815
Name:PIUSZ, ELIZABETH BAXTER (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BAXTER
Last Name:PIUSZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:BAXTER
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 CENTURY HILL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2116
Mailing Address - Country:US
Mailing Address - Phone:518-785-7283
Mailing Address - Fax:518-785-7293
Practice Address - Street 1:20 CENTURY HILL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2116
Practice Address - Country:US
Practice Address - Phone:518-785-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021526-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist