Provider Demographics
NPI:1477128221
Name:WARSHAW, ELYSSA NICOLE
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:NICOLE
Last Name:WARSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 BRIELLA DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3769
Mailing Address - Country:US
Mailing Address - Phone:561-706-1332
Mailing Address - Fax:
Practice Address - Street 1:1251 SW 11TH TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-5407
Practice Address - Country:US
Practice Address - Phone:561-706-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-159910106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician