Healthcare Provider Details

I. General information

NPI: 1598410342
Provider Name (Legal Business Name): ELAINE QIU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 GRAND ST
JERSEY CITY NJ
07302-4238
US

IV. Provider business mailing address

4 TELLICHERRY CT
JERSEY CITY NJ
07305-5503
US

V. Phone/Fax

Practice location:
  • Phone: 201-915-2918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06547700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: