Provider Demographics
NPI:1346397197
Name:BURRELLI, ELISABETH (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:BURRELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3207
Mailing Address - Country:US
Mailing Address - Phone:516-991-6287
Mailing Address - Fax:
Practice Address - Street 1:373 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3510
Practice Address - Country:US
Practice Address - Phone:516-991-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003695-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003695-1OtherMENTAL HEALTH COUNSELOR