Provider Demographics
NPI:1073229290
Name:ELSBETH EBENHOE LCSW
Entity Type:Organization
Organization Name:ELSBETH EBENHOE LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELSBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EBENHOE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-398-8835
Mailing Address - Street 1:6539 ANTHONY DR STE A
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1441
Mailing Address - Country:US
Mailing Address - Phone:585-398-8835
Mailing Address - Fax:
Practice Address - Street 1:6539 ANTHONY DR STE A
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1441
Practice Address - Country:US
Practice Address - Phone:585-398-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1639684426OtherNPI #1