Healthcare Provider Details

I. General information

NPI: 1144125154
Provider Name (Legal Business Name): ELEVATE PSYCHOLOGICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 POMEROY RD
ENFIELD CT
06082-2019
US

IV. Provider business mailing address

594 BROADWAY RM 907
NEW YORK NY
10012-3289
US

V. Phone/Fax

Practice location:
  • Phone: 917-267-2085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MOLLY TETTEH
Title or Position: OWNER
Credential: LCSW
Phone: 646-526-4779