MEDICARE: ELIZABETH KINPORTS 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	101562	NY
2	1041C0700X	Clinical Social Worker	100311	NY

General Provider Information

NPI Number	:	1982469144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KINPORTS LCSW

Provider Business Mailing Address
First Line	:	65 COOPER ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3066
Country	:	US
Telephone Number	:	814-933-6676
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 COOPER ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3066
Country	:	US
Telephone Number	:	814-933-6676
Fax Number	:

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

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	06/17/2025

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