MEDICARE: MS. JENNIFER PANSY ELLIOTT MA, R-DMT, LMSW,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	080648	NY

General Provider Information

NPI Number	:	1639244593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER PANSY ELLIOTT MA, R-DMT, LMSW,

Provider Business Mailing Address
First Line	:	260 E 188TH ST
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10458-5302
Country	:	US
Telephone Number	:	718-960-3176
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 E 188TH ST
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10458-5302
Country	:	US
Telephone Number	:	718-960-3176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	01/08/2013

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Directions to “ MS. JENNIFER PANSY ELLIOTT MA, R-DMT, LMSW,” Practice Location

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