Healthcare Provider Details

I. General information

NPI: 1548324593
Provider Name (Legal Business Name): JANE ELLIOTT S DESOUZA MPS, ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1524
US

IV. Provider business mailing address

275 NORTH ST
HARRISON NY
10528-1524
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-5290
  • Fax: 914-925-5174
Mailing address:
  • Phone: 914-925-5290
  • Fax: 914-925-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000281-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number000281-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number000281-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number000281-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: