Provider Demographics
NPI:1255486551
Name:MEAD, ELAINE RHODA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:RHODA
Last Name:MEAD
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 1:1000 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2308
Mailing Address - Country:US
Mailing Address - Phone:856-829-3955
Mailing Address - Fax:
Practice Address - Street 1:400 N CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1771
Practice Address - Country:US
Practice Address - Phone:856-829-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010111001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical