Provider Demographics
NPI:1073903787
Name:ELTAIEB, AMBER (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:ELTAIEB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:E
Other - Last Name:ROZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20073
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-0073
Mailing Address - Country:US
Mailing Address - Phone:347-517-7778
Mailing Address - Fax:
Practice Address - Street 1:601 W 150TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-2449
Practice Address - Country:US
Practice Address - Phone:347-517-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0882491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical