Healthcare Provider Details

I. General information

NPI: 1114958386
Provider Name (Legal Business Name): ZHANIIZHA ELAIVII KHANII KEVII LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMUNITY LANE
LIBERTY NY
12754-0716
US

IV. Provider business mailing address

PO BOX 97
HANKINS NY
12741-0097
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-8770
  • Fax: 845-292-4206
Mailing address:
  • Phone: 845-887-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number034777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: