Provider Demographics
NPI:1558862375
Name:ELKIN, JESSICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:ELKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SHACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:236 LIVINGSTON ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6894
Mailing Address - Country:US
Mailing Address - Phone:914-420-4565
Mailing Address - Fax:
Practice Address - Street 1:808 UNION STREET
Practice Address - Street 2:SUITE 3A, OFFICE #11
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1374
Practice Address - Country:US
Practice Address - Phone:914-420-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical