Provider Demographics
NPI:1396818969
Name:HAIES, ELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:HAIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:
Other - Last Name:GRUNWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RLCSW
Mailing Address - Street 1:1339 EAST 64TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-444-2545
Mailing Address - Fax:
Practice Address - Street 1:1623 KINGS HWY
Practice Address - Street 2:4TH FLOOR SUITE 404
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1209
Practice Address - Country:US
Practice Address - Phone:718-375-1200
Practice Address - Fax:718-382-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04385111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5184869440Medicaid
NY5184869440Medicaid