Provider Demographics
NPI:1558577338
Name:ELMORE, ANDREW MONTEVERDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MONTEVERDE
Last Name:ELMORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 80TH ST
Mailing Address - Street 2:SUITE 28G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0655
Mailing Address - Country:US
Mailing Address - Phone:212-535-5813
Mailing Address - Fax:212-535-5813
Practice Address - Street 1:401 E 80TH ST
Practice Address - Street 2:SUITE 28G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0655
Practice Address - Country:US
Practice Address - Phone:212-535-5813
Practice Address - Fax:212-535-5813
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06598103TB0200X, 103TC0700X, 103TH0004X
NY05698103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS06598-7BOtherWORKERS' COMPENSATION BOA
NYV4101Medicare ID - Type Unspecified