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Individual

ATHINA MIZERO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
13640 STATE ROUTE 22, CANAAN, NY 12029-3506
(518) 781-4567
Mailing address
123 RYCKMAN AVE APT 3R, ALBANY, NY 12208-2281
(631) 944-0817

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
099901
NY
1041C0700X
Clinical Social Worker
Primary
099901
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
099901
LISCENSE NUMBER
NY
Enumeration date
07/09/2019
Last updated
07/09/2019
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