Healthcare Provider Details

I. General information

NPI: 1558577338
Provider Name (Legal Business Name): ANDREW MONTEVERDE ELMORE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 80TH ST SUITE 28G
NEW YORK NY
10021-0655
US

IV. Provider business mailing address

401 E 80TH ST SUITE 28G
NEW YORK NY
10021-0655
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-5813
  • Fax: 212-535-5813
Mailing address:
  • Phone: 212-535-5813
  • Fax: 212-535-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number06598
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06598
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number05698
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number06598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: