Provider Demographics
NPI:1558510701
Name:ELBAUM-DAVID, JEAN (PHD, CRC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:ELBAUM-DAVID
Suffix:
Gender:F
Credentials:PHD, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1538
Mailing Address - Country:US
Mailing Address - Phone:516-509-6581
Mailing Address - Fax:
Practice Address - Street 1:1554 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3006
Practice Address - Country:US
Practice Address - Phone:516-719-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health