Provider Demographics
NPI:1396024386
Name:ELBA I SOTO
Entity Type:Organization
Organization Name:ELBA I SOTO
Other - Org Name:ELBA I SOTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LINCENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-660-0271
Mailing Address - Street 1:23 WATER GRANT ST APT 6P
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3586
Mailing Address - Country:US
Mailing Address - Phone:646-660-0271
Mailing Address - Fax:
Practice Address - Street 1:23 WATER GRANT ST APT 6P
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3586
Practice Address - Country:US
Practice Address - Phone:646-660-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069659-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization