Provider Demographics
NPI:1326222472
Name:ELVANIAN, ERIC T (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:ELVANIAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18766 JOHN J WILLIAMS HWY # 383
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4417
Mailing Address - Country:US
Mailing Address - Phone:215-439-2795
Mailing Address - Fax:
Practice Address - Street 1:18766 JOHN J WILLIAMS HWY # 383
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4417
Practice Address - Country:US
Practice Address - Phone:215-439-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 104100000X
PACW0190271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035839390004Medicaid