Provider Demographics
NPI:1629398466
Name:MCGRAW, ELAINE EAGAN (LCSW- R)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:EAGAN
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:LCSW- R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7218
Mailing Address - Country:US
Mailing Address - Phone:607-743-9798
Mailing Address - Fax:
Practice Address - Street 1:715 PADEN ST.
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-757-2842
Practice Address - Fax:607-757-2878
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041863-11041C0700X
NY4183629211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool