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General NPI Number Information
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NPI Number | 1265751382
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Entity Type | Individual
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Provider Name | IZETTA BRIGGS-BOLLING DSW, LCSW, LMHC, CAS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 2462 ROUTE 302
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City | MIDDLETOWN
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State | NY
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Zip | 10941-3230
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Country | US
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Telephone | 845-313-4494
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Fax |
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Provider Business Mailing Address
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Address Line | 37 WOODLAKE DR
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4274
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Country | US
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Telephone | 845-313-4496
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 087722
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 003343
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License Number State | NY
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