MEDICARE: MISS LAIZA PETERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	079185-1	NY

General Provider Information

NPI Number	:	1043641244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAIZA PETERS LCSW

Provider Business Mailing Address
First Line	:	2010 WILLIAMSBRIDGE RD FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1603
Country	:	US
Telephone Number	:	718-409-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 WILLIAMSBRIDGE RD FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1603
Country	:	US
Telephone Number	:	718-409-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	09/28/2015

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