Provider Demographics
NPI:1619027075
Name:BRODY, ELINOR (LCSW)
Entity Type:Individual
Prefix:
First Name:ELINOR
Middle Name:
Last Name:BRODY
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 1:133 HEATHER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3009
Mailing Address - Country:US
Mailing Address - Phone:610-664-1773
Mailing Address - Fax:610-664-1533
Practice Address - Street 1:133 HEATHER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3009
Practice Address - Country:US
Practice Address - Phone:610-664-1773
Practice Address - Fax:610-664-1533
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical