Provider Demographics
NPI:1609186535
Name:ELIAS, KRISTIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:ELIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CLINTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1404
Mailing Address - Country:US
Mailing Address - Phone:585-232-1840
Mailing Address - Fax:585-232-8419
Practice Address - Street 1:30 CLINTON AVE N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1404
Practice Address - Country:US
Practice Address - Phone:585-232-1840
Practice Address - Fax:585-232-8419
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0764801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical