Provider Demographics
NPI:1427129048
Name:DUDDY-NAVARETTA, ELIZABETH ANNE (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:DUDDY-NAVARETTA
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:DUDDY-NAVARETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 OLEETA RD.
Mailing Address - Street 2:BILLING ONLY
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766
Mailing Address - Country:US
Mailing Address - Phone:631-929-0121
Mailing Address - Fax:631-361-3706
Practice Address - Street 1:538 ROUTE 25A
Practice Address - Street 2:SUITE 5
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778
Practice Address - Country:US
Practice Address - Phone:631-929-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05020211041C0700X
NYR050202-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61024702538Medicaid
203434OtherMHN
0502021N01OtherHIP
122802OtherVYTRA
271679000OtherEMPIRE MAGELLAN
NY6102470253Medicaid
P2571549OtherOXFORD
225296OtherVALUE OPTIONS
NY6102470253Medicaid
NY61024702538Medicaid