Provider Demographics
NPI:1407079213
Name:KLIONSKY, ELAINE JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:JOAN
Last Name:KLIONSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 CHEVY CHASE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4854
Mailing Address - Country:US
Mailing Address - Phone:301-641-8406
Mailing Address - Fax:
Practice Address - Street 1:4809 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3009
Practice Address - Country:US
Practice Address - Phone:301-641-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03260103T00000X, 103TF0000X, 103TP2701X, 103TC0700X
DC1826103T00000X, 103TC0700X, 103TF0000X, 103TP2701X
MD3260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy