Healthcare Provider Details

I. General information

NPI: 1124147855
Provider Name (Legal Business Name): ELIZABETH JILL BRACKIS-COTT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 2000
HAWTHORNE NY
10532-2175
US

IV. Provider business mailing address

44 RIVERVIEW RD
IRVINGTON NY
10533-1326
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7700
  • Fax:
Mailing address:
  • Phone: 917-596-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number014227
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: