=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568837409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISHEVA RENA KATZ PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2015
-----------------------------------------------------
Last Update Date | 06/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HAMASPIK WAY
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10950-8451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-655-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 VAN HOUTEN AVE APT 1
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-316-6592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 022597
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------