Provider Demographics
NPI:1407578461
Name:THOMOPOULOS, ELENA ANASTASIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:ANASTASIA
Last Name:THOMOPOULOS
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 1:633 HARING FARM CT
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6481
Mailing Address - Country:US
Mailing Address - Phone:201-615-9852
Mailing Address - Fax:
Practice Address - Street 1:20 WILSEY SQ
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3793
Practice Address - Country:US
Practice Address - Phone:201-409-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00681600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist