Provider Demographics
NPI:1053519371
Name:ZISELMAN, JODI ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:ELLEN
Last Name:ZISELMAN
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 1:1958 NANTUCKET RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1609
Mailing Address - Country:US
Mailing Address - Phone:516-867-3943
Mailing Address - Fax:
Practice Address - Street 1:66 LINCOLN CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5743
Practice Address - Country:US
Practice Address - Phone:516-330-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053751-71041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical