Provider Demographics
NPI:1588787402
Name:LAURA SUE NIZEWITZ
Entity type:Organization
Organization Name:LAURA SUE NIZEWITZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NIZEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-988-7916
Mailing Address - Street 1:200 MIDWAY PARK DR
Mailing Address - Street 2:SUITE 1 WEST
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2642
Mailing Address - Country:US
Mailing Address - Phone:845-988-7916
Mailing Address - Fax:845-343-4545
Practice Address - Street 1:200 MIDWAY PARK DR
Practice Address - Street 2:SUITE 1 WEST
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2642
Practice Address - Country:US
Practice Address - Phone:845-343-7274
Practice Address - Fax:845-343-4545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURA SUE NIZEWITZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-06
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW-R0287261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty