Provider Demographics
NPI:1508414897
Name:ELIA, RANDI MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:MARIE
Last Name:ELIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 VALLEY RD OFC 6D
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1470
Mailing Address - Country:US
Mailing Address - Phone:201-298-3190
Mailing Address - Fax:
Practice Address - Street 1:622 VALLEY RD OFC 6D
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1470
Practice Address - Country:US
Practice Address - Phone:201-298-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00467000101YM0800X
NJ37PC00855300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health