Provider Demographics
NPI:1497853030
Name:ELLIOT, SUE ANN (MSW NY STATE LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:MSW NY STATE LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SQUASHVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12833
Mailing Address - Country:US
Mailing Address - Phone:518-584-0990
Mailing Address - Fax:
Practice Address - Street 1:409 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-584-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022517 LCSW103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R022517OtherNY LIC
55418BMedicare ID - Type Unspecified