Elisse Marie Antczak, LCSWR
Individual provider Active NPI Clinical Social Worker · Snyder, NY
NPI 1316008352 · NPPES record last updated Sep 7, 2022
Key facts
- NPI
- 1316008352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- R048061-01 (NY)
- Practice address
- 3960 Harlem Rd Ste 10
Snyder, NY 14226-4706 - Phone
- (716) 238-0829
- Fax
- (716) 898-8802
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R048061-01 | NY | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R048061-01 | NY | Yes |
Addresses
Primary practice location
3960 Harlem Rd Ste 10
Snyder, NY 14226-4706
Mailing address
3960 Sheridan Drive
Suite 10
Snyder, NY 14226
Phone (716) 238-0829
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6211545 | Other | NY | INDEPENDENT HEALTH |
| 00026849603 | Other | NY | UNIVERA |
| 000526673002 | Other | NY | BLUE CROSS & BLUE SHIELD |
Other providers in Snyder, NY
- Jack Charles Anchin
- Satish Arora
- Azure Aesthetics and Oculofacial Plastic Surgery PC
- Barbara J Boehler
- Hope Stephanie Bongiorno
- Robert Louis Bork
All providers in Snyder, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.