Provider Demographics
NPI:1871796516
Name:HAVERSHAM-BROWN, ELIZABETH PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PATRICIA
Last Name:HAVERSHAM-BROWN
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 1:111 W OLD COUNTRY RD
Mailing Address - Street 2:SUITE 2 B
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4003
Mailing Address - Country:US
Mailing Address - Phone:516-433-6069
Mailing Address - Fax:516-433-6245
Practice Address - Street 1:111 W OLD COUNTRY RD
Practice Address - Street 2:SUITE 2 B
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4003
Practice Address - Country:US
Practice Address - Phone:516-433-6069
Practice Address - Fax:516-433-6245
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10860101YA0400X
NY0707261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical