Healthcare Provider Details

I. General information

NPI: 1992031066
Provider Name (Legal Business Name): LAURA SUE NIZEWITZ LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIDWAY PARK DR SUITE 1 WEST
MIDDLETOWN NY
10940-2642
US

IV. Provider business mailing address

200 MIDWAY PARK DR SUITE 1 WEST
MIDDLETOWN NY
10940-2642
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-7274
  • Fax: 845-343-4545
Mailing address:
  • Phone: 845-343-7274
  • Fax: 845-343-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-R028726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: