Provider Demographics
NPI:1275675399
Name:ELKO, SUSAN E (LRC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:ELKO
Suffix:
Gender:F
Credentials:LRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 EMMANS RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9041
Mailing Address - Country:US
Mailing Address - Phone:973-252-1834
Mailing Address - Fax:
Practice Address - Street 1:149 EMMANS RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9041
Practice Address - Country:US
Practice Address - Phone:973-252-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37RC00101800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health