Provider Demographics
NPI:1699910661
Name:WHITE, ELIZABETH I (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:I
Last Name:WHITE
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 1:20 SURREY CT
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-6414
Mailing Address - Country:US
Mailing Address - Phone:516-658-2057
Mailing Address - Fax:
Practice Address - Street 1:2415 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932
Practice Address - Country:US
Practice Address - Phone:516-658-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069643-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical