Provider Demographics
NPI:1184226995
Name:ELLIOTT, ENOCH ROSS
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:ROSS
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RUTLAND RD APT D8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5476
Mailing Address - Country:US
Mailing Address - Phone:347-399-8450
Mailing Address - Fax:718-485-7780
Practice Address - Street 1:2094 PITKIN AVE RM C-32A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3509
Practice Address - Country:US
Practice Address - Phone:718-485-7760
Practice Address - Fax:718-486-7780
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)