Healthcare Provider Details

I. General information

NPI: 1194861393
Provider Name (Legal Business Name): ERIC KATZ LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 CHURCH ST
HOOSICK FALLS NY
12090-1642
US

IV. Provider business mailing address

1600 7TH AVE STE 3
TROY NY
12180-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-0694
  • Fax: 518-686-4862
Mailing address:
  • Phone: 518-270-2646
  • Fax: 518-270-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR069346-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: