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NPI Code Detail

MEDICARE: ELIZABETH THERESA BRUINIX-PARRIS LCSW

MEDICARE: ELIZABETH THERESA BRUINIX-PARRIS 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
11041C0700XClinical Social Worker090288NY

General Provider Information

NPI Number : 1588440853
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH THERESA BRUINIX-PARRIS LCSW
Provider Business Mailing Address
First Line : 1108 KINGS HWY STE 3A
Second Line :
City : CHESTER
State : NY
Zip : 10918-3140
Country : US
Telephone Number : 845-800-7663
Fax Number :
Provider Business Practice Location Address
First Line : 1108 KINGS HWY
Second Line :
City : CHESTER
State : NY
Zip : 10918-3139
Country : US
Telephone Number : 845-800-7663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2023
Last Update Date : 03/03/2024

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