Provider Demographics
NPI:1003806985
Name:GRODNER, ELANA ESTHER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELANA
Middle Name:ESTHER
Last Name:GRODNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 W PENN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3130
Mailing Address - Country:US
Mailing Address - Phone:516-489-2652
Mailing Address - Fax:
Practice Address - Street 1:1810 AVENUE N
Practice Address - Street 2:SUITE 2G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6105
Practice Address - Country:US
Practice Address - Phone:516-489-2652
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048257-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND7421Medicare ID - Type Unspecified