Healthcare Provider Details

I. General information

NPI: 1720637010
Provider Name (Legal Business Name): ELIZABETH BRETZ LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/28/2023
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MAIN ST STE 115
NYACK NY
10960-3040
US

IV. Provider business mailing address

8 CARLANN LN
VALLEY COTTAGE NY
10989-1408
US

V. Phone/Fax

Practice location:
  • Phone: 845-202-9881
  • Fax: 866-594-4569
Mailing address:
  • Phone: 845-202-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH ANN BRETZ
Title or Position: DIRECTOR/OWNER
Credential: LCSW
Phone: 845-202-9881