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Individual
ELISSE MARIE ANTCZAK
Active
Individual
ELISSE MARIE ANTCZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSWR
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R048061-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026849603
UNIVERA
NY
01
—
000526673002
BLUE CROSS & BLUE SHIELD
NY
01
—
6211545
INDEPENDENT HEALTH
NY
Enumeration date
12/13/2006
Last updated
09/07/2022
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