Healthcare Provider Details

I. General information

NPI: 1033050380
Provider Name (Legal Business Name): ELLIOT P CORNELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 EASTWOOD DR STE 102
MADISON WI
53704-5387
US

IV. Provider business mailing address

502 APOLLO WAY APT 403
MADISON WI
53718-2999
US

V. Phone/Fax

Practice location:
  • Phone: 608-291-3676
  • Fax:
Mailing address:
  • Phone: 608-692-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12607123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: