Healthcare Provider Details

I. General information

NPI: 1023520699
Provider Name (Legal Business Name): REBECCA ELOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MADISON AVE
NEW YORK NY
10016-0701
US

IV. Provider business mailing address

274 MADISON AVE
NEW YORK NY
10016-0701
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-1773
  • Fax: 646-665-4427
Mailing address:
  • Phone: 212-203-1773
  • Fax: 646-665-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178020172
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: