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General NPI Number Information
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NPI Number | 1760449318
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Entity Type | Individual
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Provider Name | DAVID ELISCU MS, MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 200 ORCHARD STREET, SUITE 301 SCRANTON PROFESSIONAL CENTER
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City | NEW HAVEN
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State | CT
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Zip | 06511
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Country | US
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Telephone | 203-848-0606
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Fax | 203-624-6738
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Provider Business Mailing Address
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Address Line | 19 COURT ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-6922
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Country | US
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Telephone | 203-848-0606
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Fax | 203-624-6738
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004902
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004902
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License Number State | CT
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