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General NPI Number Information
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NPI Number | 1205840600
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Entity Type | Individual
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Provider Name | ELIZABETH E VERGOZ PH D
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 65 N MAPLE AVE SUITE 301
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3233
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Country | US
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Telephone | 201-655-5434
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Fax |
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Provider Business Mailing Address
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Address Line | 65 N MAPLE AVE SUITE 301
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3233
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Country | US
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Telephone | 201-655-5434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0117161
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4253
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License Number State | NJ
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