Provider Demographics
NPI:1598931701
Name:MANGER, ELIZABETH ELAM (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELAM
Last Name:MANGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:19 W 34TH ST
Mailing Address - Street 2:PENTHOUSE SUITE, 13TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:646-872-7129
Mailing Address - Fax:212-239-0948
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PENTHOUSE SUITE, 13TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:646-872-7129
Practice Address - Fax:212-239-0948
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056999-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical