Provider Demographics
NPI:1376706176
Name:BOURGEOIS-MUNOZ, ELISE J (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:J
Last Name:BOURGEOIS-MUNOZ
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:DR
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW, LCSW
Mailing Address - Street 1:235 MAIN ST STE 520
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2421
Mailing Address - Country:US
Mailing Address - Phone:914-533-4950
Mailing Address - Fax:
Practice Address - Street 1:235 MAIN ST STE 520
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-533-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0077771041C0700X
TN75711041C0700X
CT107281041C0700X
NJ44SC059723001041C0700X
NCC0160901041C0700X
FLSW219301041C0700X
NY0788241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical