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General NPI Number Information
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NPI Number | 1457449076
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Entity Type | Individual
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Provider Name | IA ELUA LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2020 CONEY ISLAND AVE JBFCS, MID-BROOKLYN CLINIC
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City | BROOKLYN
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State | NY
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Zip | 11223-2329
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Country | US
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Telephone | 718-676-4242
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Fax | 718-676-4216
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Provider Business Mailing Address
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Address Line | 6135 98TH ST APT. 7J
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City | REGO PARK
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State | NY
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Zip | 11374-1426
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Country | US
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Telephone | 718-699-8928
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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 | R053196-1
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License Number State | NY
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