Healthcare Provider Details

I. General information

NPI: 1588148605
Provider Name (Legal Business Name): ELISA ROUPENIAN TOHA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELISA ROUPENIAN

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 4TH AVE # 220
BROOKLYN NY
11209-7006
US

IV. Provider business mailing address

9201 4TH AVE # 220
BROOKLYN NY
11209-7006
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-6444
  • Fax:
Mailing address:
  • Phone: 718-238-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: