Healthcare Provider Details

I. General information

NPI: 1720463078
Provider Name (Legal Business Name): LISA MARIE BEDNARZ LCSW, ACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 BROADWAY FL 4
NEW YORK NY
10023-7603
US

IV. Provider business mailing address

525 E 68TH ST DEPT OF SOCIAL WORK
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-333-3444
  • Fax:
Mailing address:
  • Phone: 212-746-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: