Provider Demographics
NPI:1124584495
Name:NACLERIO, ELANA (MA, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:ELANA
Middle Name:
Last Name:NACLERIO
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SOUNDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1445
Mailing Address - Country:US
Mailing Address - Phone:631-546-8400
Mailing Address - Fax:
Practice Address - Street 1:10 SOUNDVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-1445
Practice Address - Country:US
Practice Address - Phone:631-546-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002088221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist