Basic Information
| Provider Information | |||||||||
| NPI: | 1922778497 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELLAROCCO | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CASEY | ||||||||
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| Credential: | MHC-P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 WILLOWBROOK RD | ||||||||
| Address2: | |||||||||
| City: | QUEENSBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128045882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189267100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 GRAY AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWICH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128341138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189269011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2021 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 111948-01 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.