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General NPI Number Information
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NPI Number | 1235428145
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Entity Type | Individual
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Provider Name | DAMIAN MICHAEL GERLACH ELIAS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 1140 BROADWAY STE 204
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City | NEW YORK
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State | NY
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Zip | 10001-7504
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Country | US
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Telephone | 215-327-2504
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Fax |
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Provider Business Mailing Address
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Address Line | 582 5TH ST APT #2B
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City | BROOKLYN
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State | NY
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Zip | 11215-3534
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Country | US
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Telephone | 215-327-2504
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 019554
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License Number State | NY
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