Provider Demographics
NPI:1053858043
Name:HOLBEIN, ELISABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:HOLBEIN
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0608
Mailing Address - Country:US
Mailing Address - Phone:315-366-2327
Mailing Address - Fax:
Practice Address - Street 1:15 E GENESEE ST STE 203
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2564
Practice Address - Country:US
Practice Address - Phone:315-303-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY1041C0700X
NY0909001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker