Provider Demographics
NPI:1043543127
Name:ELLIOTT LEAVY, ELISHA J (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:J
Last Name:ELLIOTT LEAVY
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 1:320 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:717-285-5302
Practice Address - Street 1:3897 ADLER PL
Practice Address - Street 2:SUITE 130, BLDG C
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9425
Practice Address - Country:US
Practice Address - Phone:484-895-3720
Practice Address - Fax:484-895-3723
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0158171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168930LTDMedicare PIN