Healthcare Provider Details

I. General information

NPI: 1073020467
Provider Name (Legal Business Name): ELIZABETH GDOVIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2018
Last Update Date: 01/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W MAIN ST
SIDNEY NY
13838-1601
US

IV. Provider business mailing address

95 W MAIN ST
SIDNEY NY
13838-1601
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-2135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number091515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: