Provider Demographics
NPI:1457626020
Name:LEBOW, ELIOT (LCSW, CDE)
Entity Type:Individual
Prefix:MR
First Name:ELIOT
Middle Name:
Last Name:LEBOW
Suffix:
Gender:M
Credentials:LCSW, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W 96TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6191
Mailing Address - Country:US
Mailing Address - Phone:917-272-4829
Mailing Address - Fax:
Practice Address - Street 1:323 W 96TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6191
Practice Address - Country:US
Practice Address - Phone:917-272-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21320600174H00000X, 174H00000X
NY0782461041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21320600OtherCERTIFICATION BOARD FOR DIABETES CARE AND EDUCATION