Provider Demographics
NPI:1023553609
Name:MOLLIE ELIASOF LCSW THERAPY PLLC
Entity Type:Organization
Organization Name:MOLLIE ELIASOF LCSW THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIASOF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-685-4285
Mailing Address - Street 1:315 W 57TH ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3158
Mailing Address - Country:US
Mailing Address - Phone:646-685-4285
Mailing Address - Fax:
Practice Address - Street 1:315 W 57TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3158
Practice Address - Country:US
Practice Address - Phone:646-685-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15081038131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty