Provider Demographics
NPI:1396402137
Name:MUNDEY, ELENA MELISSA (LGSW)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MELISSA
Last Name:MUNDEY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 U ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2332
Mailing Address - Country:US
Mailing Address - Phone:917-482-6823
Mailing Address - Fax:
Practice Address - Street 1:403 U ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2332
Practice Address - Country:US
Practice Address - Phone:917-482-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker