Provider Demographics
NPI:1437834397
Name:ESKENAZI, ELCHANAN YOCHANAN (LSW)
Entity Type:Individual
Prefix:
First Name:ELCHANAN
Middle Name:YOCHANAN
Last Name:ESKENAZI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 LATCHES LN
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3015
Mailing Address - Country:US
Mailing Address - Phone:610-664-3549
Mailing Address - Fax:
Practice Address - Street 1:164 LATCHES LN
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3015
Practice Address - Country:US
Practice Address - Phone:917-579-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06888100104100000X
PASW139723104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker