Provider Demographics
NPI:1538812896
Name:WEINBAUM, ELIZABETH (LCSW-R)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WEINBAUM
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CAMILLE LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4702
Mailing Address - Country:US
Mailing Address - Phone:631-879-7285
Mailing Address - Fax:
Practice Address - Street 1:24 CAMILLE LN
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4702
Practice Address - Country:US
Practice Address - Phone:631-879-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical