Provider Demographics
NPI:1114245859
Name:GREENBERG, ELANA T (LCSW)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:T
Last Name:GREENBERG
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-0008
Mailing Address - Country:US
Mailing Address - Phone:914-525-2222
Mailing Address - Fax:914-241-7043
Practice Address - Street 1:120 KISCO AVE
Practice Address - Street 2:STE. K
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1415
Practice Address - Country:US
Practice Address - Phone:914-525-2222
Practice Address - Fax:914-241-7043
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0489701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02158116Medicaid
NYN68341Medicare PIN