Provider Demographics
NPI:1962422865
Name:LANDSBERG, ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:LANDSBERG
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 1:40 OCEAN PKWY
Mailing Address - Street 2:5C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1549
Mailing Address - Country:US
Mailing Address - Phone:718-972-9552
Mailing Address - Fax:718-972-9552
Practice Address - Street 1:40 OCEAN PKWY
Practice Address - Street 2:5C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1549
Practice Address - Country:US
Practice Address - Phone:718-972-9552
Practice Address - Fax:718-972-9552
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0239191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN63741Medicare ID - Type Unspecified