Provider Demographics
NPI:1417254038
Name:BELTRAM, ELIDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIDE
Middle Name:
Last Name:BELTRAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELIDE
Other - Middle Name:
Other - Last Name:BELTRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7002 BOULEVARD EAST APT 34E
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4946
Mailing Address - Country:US
Mailing Address - Phone:201-861-6318
Mailing Address - Fax:
Practice Address - Street 1:41 E 11TH ST # 51
Practice Address - Street 2:WASHINGTON SQUARE INSTITUTE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:212-477-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst