=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326556499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH MARY CINCOTTA LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2018
-----------------------------------------------------
Last Update Date | 01/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 327 BEACH 19TH ST
-----------------------------------------------------
City | FAR ROCKAWAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11691-4423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-869-7768
-----------------------------------------------------
Fax | 718-869-5368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 327 BEACH 19TH ST
-----------------------------------------------------
City | FAR ROCKAWAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11691-4423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-869-7768
-----------------------------------------------------
Fax | 718-869-5368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 076861-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------