Healthcare Provider Details

I. General information

NPI: 1164666830
Provider Name (Legal Business Name): ELIZABETH GIDUZ MSW, LCSW, MSRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 04/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST STE 112
CHAPEL HILL NC
27516-4493
US

IV. Provider business mailing address

107 ELLSWORTH PL
CHAPEL HILL NC
27516-4624
US

V. Phone/Fax

Practice location:
  • Phone: 919-969-9611
  • Fax:
Mailing address:
  • Phone: 919-967-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002063
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: