Provider Demographics
NPI:1003953506
Name:ELIASOF, R. HOPE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:R. HOPE
Middle Name:
Last Name:ELIASOF
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2423
Mailing Address - Country:US
Mailing Address - Phone:201-767-1975
Mailing Address - Fax:201-767-8897
Practice Address - Street 1:666 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1449
Practice Address - Country:US
Practice Address - Phone:201-445-0550
Practice Address - Fax:201-767-8897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00813 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ432371Medicare ID - Type UnspecifiedLICENSED CLINICAL SOCIAL