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General NPI Number Information
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NPI Number | 1215045570
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Entity Type | Individual
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Provider Name | DOUGLAS D ELSTON L.C.S.W.-R
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 HOSPITAL RD
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City | WALTON
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State | NY
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Zip | 13856-1454
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Country | US
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Telephone | 607-865-8255
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Fax | 607-865-7424
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Provider Business Mailing Address
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Address Line | 9 MARVIN AVE
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City | WALTON
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State | NY
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Zip | 13856-1419
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Country | US
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Telephone | 607-865-8923
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R060853-1
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License Number State | NY
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