Provider Demographics
NPI:1023281391
Name:ESPINOZA, LIZ B (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:LIZ
Middle Name:B
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3302
Mailing Address - Country:US
Mailing Address - Phone:518-227-0847
Mailing Address - Fax:518-888-3324
Practice Address - Street 1:401 NEW KARNER RD
Practice Address - Street 2:ONTRACKNY
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3840
Practice Address - Country:US
Practice Address - Phone:518-292-5452
Practice Address - Fax:518-434-3286
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076654-1104100000X
NY0808881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04597013Medicaid