Provider Demographics
NPI:1215000765
Name:MEIZLISH, ELAINE (MSW LISW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:MEIZLISH
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 ASPEN DR
Mailing Address - Street 2:STE101B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5459
Mailing Address - Country:US
Mailing Address - Phone:505-471-0402
Mailing Address - Fax:505-431-6850
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:STE101B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5459
Practice Address - Country:US
Practice Address - Phone:505-471-0402
Practice Address - Fax:505-431-6850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-079081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical