Healthcare Provider Details

I. General information

NPI: 1720289499
Provider Name (Legal Business Name): ELIZABETH A. BIENZ LICSW, MSSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GOTHIC ST
NORTHAMPTON MA
01060-3059
US

IV. Provider business mailing address

60 WELLS ST
GREENFIELD MA
01301-2354
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-5810
  • Fax:
Mailing address:
  • Phone: 413-588-4327
  • Fax: 413-775-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114220
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: