Healthcare Provider Details

I. General information

NPI: 1669426359
Provider Name (Legal Business Name): ERIC DAVID WAITZMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST NEW YORK HARBOR DEPARTMENT OF VETERAN'S AFAIRS
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

8838 20TH AVE
BROOKLYN NY
11214-7304
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax: 212-951-3391
Mailing address:
  • Phone: 212-686-7500
  • Fax: 212-951-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071628-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: