Provider Demographics
NPI:1447560776
Name:NATIELLO, ELISA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:NATIELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N HIATUS ROAD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026
Mailing Address - Country:US
Mailing Address - Phone:954-431-0411
Mailing Address - Fax:954-431-0413
Practice Address - Street 1:700 N HIATUS ROAD
Practice Address - Street 2:SUITE 213
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-431-0411
Practice Address - Fax:954-431-0413
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical