Basic Information
| Provider Information | |||||||||
| NPI: | 1871971622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CO | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 N MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109601525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 42 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109603204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC05763300 | NJ | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.