Provider Demographics
NPI:1619416724
Name:ELYSE GULI LICENSED CLINICAL SOCIAL WORKER LLC
Entity Type:Organization
Organization Name:ELYSE GULI LICENSED CLINICAL SOCIAL WORKER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-887-0139
Mailing Address - Street 1:106 ROUTE 23 NORTH, #1003
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:201-887-0139
Mailing Address - Fax:
Practice Address - Street 1:106 ROUTE 23 N, #1003
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:201-887-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055503001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty