Provider Demographics
NPI:1770788648
Name:POLIZZI, ELIZABETH M (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 7TH AVE
Mailing Address - Street 2:REVENUE MANAGEMENT
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2733
Mailing Address - Country:US
Mailing Address - Phone:682-885-4157
Mailing Address - Fax:682-885-1903
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-1055
Practice Address - Fax:682-885-1062
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker