Provider Demographics
NPI:1225214265
Name:EDELMAN, ELAINE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RICHARD RD.
Mailing Address - Street 2:
Mailing Address - City:E. BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:917-494-1617
Mailing Address - Fax:
Practice Address - Street 1:224 ROUTE 18 NORTH
Practice Address - Street 2:
Practice Address - City:E. BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:917-494-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC011733001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N51711Medicare PIN