Healthcare Provider Details

I. General information

NPI: 1023434701
Provider Name (Legal Business Name): ELISSA FRIEDMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WALT WHITMAN RD STE LL1
MELVILLE NY
11747-2215
US

IV. Provider business mailing address

4 NEWCASTLE AVE
PLAINVIEW NY
11803-2706
US

V. Phone/Fax

Practice location:
  • Phone: 516-698-5511
  • Fax:
Mailing address:
  • Phone: 516-728-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73074620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: