Healthcare Provider Details

I. General information

NPI: 1760893820
Provider Name (Legal Business Name): CINDY ELKO PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CHAPMAN RD SUITE 205C
NEWARK DE
19702-5490
US

IV. Provider business mailing address

44 CORNWALL DR
NEWARK DE
19711-7734
US

V. Phone/Fax

Practice location:
  • Phone: 302-533-7582
  • Fax: 302-553-7584
Mailing address:
  • Phone: 302-229-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2014602992
License Number StateDE

VIII. Authorized Official

Name: DR. CINDY ELKO
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 302-229-2110