Provider Demographics
NPI:1609918051
Name:MAYE, ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:MAYE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:MAYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 604465
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-4465
Mailing Address - Country:US
Mailing Address - Phone:646-745-5500
Mailing Address - Fax:
Practice Address - Street 1:20235 47TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3026
Practice Address - Country:US
Practice Address - Phone:718-707-7004
Practice Address - Fax:718-631-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057872-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY057872OtherHIP PROVIDER I.D. NUMBER
NY19259886Medicaid
NY057872OtherHIP PROVIDER I.D. NUMBER