Provider Demographics
NPI:1386843316
Name:STERN, ELISSA (LCSW, MPH)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5606
Mailing Address - Country:US
Mailing Address - Phone:914-381-6110
Mailing Address - Fax:
Practice Address - Street 1:930 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1629
Practice Address - Country:US
Practice Address - Phone:914-381-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07095511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical