Provider Demographics
NPI:1720176621
Name:KATZ, ELLIOT (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 RECKLESS PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1703
Mailing Address - Country:US
Mailing Address - Phone:732-758-1188
Mailing Address - Fax:732-530-4145
Practice Address - Street 1:41 RECKLESS PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1703
Practice Address - Country:US
Practice Address - Phone:732-758-1188
Practice Address - Fax:732-530-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 06668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health