Healthcare Provider Details

I. General information

NPI: 1023281391
Provider Name (Legal Business Name): LIZ B. ESPINOZA LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NEW KARNER RD ONTRACKNY
ALBANY NY
12205-3840
US

IV. Provider business mailing address

732 MADISON AVENUE
ALBANY NY
12208-3302
US

V. Phone/Fax

Practice location:
  • Phone: 518-292-5452
  • Fax: 518-434-3286
Mailing address:
  • Phone: 518-227-0847
  • Fax: 518-888-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number076654-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: