Healthcare Provider Details

I. General information

NPI: 1831641091
Provider Name (Legal Business Name): ELIZABETH MOCKRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 FRANKLIN ST
BALLSTON SPA NY
12020-2315
US

IV. Provider business mailing address

473 FRANKLIN ST
BALLSTON SPA NY
12020-2315
US

V. Phone/Fax

Practice location:
  • Phone: 518-728-6439
  • Fax:
Mailing address:
  • Phone: 518-728-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1512081
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089443
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10194
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: