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NPI Code Detail

MEDICARE: MARK RICHARD ELLIOTT LCSW

MEDICARE: MARK RICHARD ELLIOTT LCSW
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
1101YM0800XMental Health CounselorR041228-1NY

General Provider Information

NPI Number : 1891879987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK RICHARD ELLIOTT LCSW
Provider Business Mailing Address
First Line : 20 SWEETBRIAR DR
Second Line :
City : GANSEVOORT
State : NY
Zip : 12831-2526
Country : US
Telephone Number : 518-584-3600
Fax Number : 518-584-3747
Provider Business Practice Location Address
First Line : 30 CRESCENT AVE
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-5142
Country : US
Telephone Number : 518-584-3600
Fax Number : 518-584-3747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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