Healthcare Provider Details

I. General information

NPI: 1386696961
Provider Name (Legal Business Name): ELYSE GAIL GARLICK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 STATE RD
PRINCETON NJ
08540-1304
US

IV. Provider business mailing address

33 STATE RD
PRINCETON NJ
08540-1304
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-9329
  • Fax: 609-924-1256
Mailing address:
  • Phone: 609-924-9329
  • Fax: 609-924-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00439500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: