Provider Demographics
NPI:1376814913
Name:ISSENDORF, ELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:ISSENDORF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:KROTOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 W 47TH STR. APT N7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2978
Mailing Address - Country:US
Mailing Address - Phone:917-650-6325
Mailing Address - Fax:
Practice Address - Street 1:516 W 47TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:917-650-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0835491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical