Healthcare Provider Details

I. General information

NPI: 1497853030
Provider Name (Legal Business Name): SUE ANN ELLIOT MSW NY STATE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MAPLE AVE
SARATOGA SPRINGS NY
12866
US

IV. Provider business mailing address

103 SQUASHVILLE ROAD
GREENFIELD CENTER NY
12833
US

V. Phone/Fax

Practice location:
  • Phone: 518-584-0990
  • Fax:
Mailing address:
  • Phone: 518-584-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberR022517 LCSW
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR022517 LCSW
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: