Provider Demographics
NPI:1174000293
Name:DANGINIS, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:DANGINIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENI
Other - Middle Name:
Other - Last Name:DANGINIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4277 65TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5054
Mailing Address - Country:US
Mailing Address - Phone:718-429-2000
Mailing Address - Fax:718-334-0057
Practice Address - Street 1:4277 65TH PL
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5054
Practice Address - Country:US
Practice Address - Phone:718-429-2000
Practice Address - Fax:718-334-0057
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool