Healthcare Provider Details

I. General information

NPI: 1740119916
Provider Name (Legal Business Name): ELISHEVA LESLIE KAROLINA WATMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 N MAIN ST
SPRING VALLEY NY
10977-4020
US

IV. Provider business mailing address

475 W 186TH ST APT 6G
NEW YORK NY
10033-2909
US

V. Phone/Fax

Practice location:
  • Phone: 713-725-4467
  • Fax:
Mailing address:
  • Phone: 713-725-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130-522
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: