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General NPI Number Information
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NPI Number | 1265101463
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Entity Type | Individual
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Provider Name | BRITNEY ELANA THEMISTOCLES LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 34 S BROADWAY STE 208
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4431
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Country | US
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Telephone | 845-389-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 70 WEST ST APT B13
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City | HARRISON
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State | NY
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Zip | 10528-4016
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Country | US
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Telephone | 845-389-0894
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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 | 09120501
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License Number State | NY
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