Provider Demographics
NPI:1588440853
Name:BRUINIX-PARRIS, ELIZABETH THERESA (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THERESA
Last Name:BRUINIX-PARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 KINGS HWY STE 3A
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-3140
Mailing Address - Country:US
Mailing Address - Phone:845-800-7663
Mailing Address - Fax:
Practice Address - Street 1:1108 KINGS HWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-3139
Practice Address - Country:US
Practice Address - Phone:845-800-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0902881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical