Provider Demographics
NPI:1477837888
Name:EILENBERG WILSON, MARA ELISE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:ELISE
Last Name:EILENBERG WILSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W 187TH ST
Mailing Address - Street 2:APT. 6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1225
Mailing Address - Country:US
Mailing Address - Phone:212-927-8134
Mailing Address - Fax:212-543-6660
Practice Address - Street 1:825 W 187TH ST
Practice Address - Street 2:APT. 6H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1225
Practice Address - Country:US
Practice Address - Phone:212-927-8134
Practice Address - Fax:212-543-6660
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047797-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical