Provider Demographics
NPI:1215363775
Name:ELGORT, JOAN (MA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:ELGORT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3211
Mailing Address - Country:US
Mailing Address - Phone:631-549-2067
Mailing Address - Fax:
Practice Address - Street 1:15 E 22ND ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3211
Practice Address - Country:US
Practice Address - Phone:631-549-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor