Provider Demographics
NPI:1396832564
Name:MONIN, ELLIOTT J (MS; PD; NCSP)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:J
Last Name:MONIN
Suffix:
Gender:M
Credentials:MS; PD; NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2029
Mailing Address - Country:US
Mailing Address - Phone:516-569-6563
Mailing Address - Fax:516-569-7726
Practice Address - Street 1:893 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2029
Practice Address - Country:US
Practice Address - Phone:516-569-6563
Practice Address - Fax:516-569-7726
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001309-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health