Healthcare Provider Details

I. General information

NPI: 1437674116
Provider Name (Legal Business Name): ELIANA REDLICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 09/26/2020
Certification Date: 09/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 EDGEMOUNT RD
EDISON NJ
08817-2904
US

IV. Provider business mailing address

37 EDGEMOUNT RD
EDISON NJ
08817-2904
US

V. Phone/Fax

Practice location:
  • Phone: 516-242-4906
  • Fax:
Mailing address:
  • Phone: 516-242-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05930500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096892
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: