Provider Demographics
NPI:1336556018
Name:WISCHNIA, ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WISCHNIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 50TH ST
Mailing Address - Street 2:APT 5F
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4353
Mailing Address - Country:US
Mailing Address - Phone:610-245-7516
Mailing Address - Fax:
Practice Address - Street 1:4129 50TH ST
Practice Address - Street 2:APT 5F
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4353
Practice Address - Country:US
Practice Address - Phone:610-245-7516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst