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General NPI Number Information
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NPI Number | 1770529968
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Entity Type | Individual
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Provider Name | MARCIA ELLIAS
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 228 E BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10002-5601
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Country | US
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Telephone | 212-475-7755
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Fax | 212-475-5035
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Provider Business Mailing Address
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Address Line | 1 OLD COUNTRY RD SUITE 271
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City | CARLE PLACE
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State | NY
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Zip | 11514-1801
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Country | US
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Telephone | 800-725-6280
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Fax | 800-725-6380
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0101851
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License Number State | NY
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