Provider Demographics
NPI:1639244593
Name:ELLIOTT, JENNIFER PANSY (MA, R-DMT, LMSW,)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PANSY
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA, R-DMT, LMSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 188TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5302
Mailing Address - Country:US
Mailing Address - Phone:718-960-3176
Mailing Address - Fax:
Practice Address - Street 1:260 E 188TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:718-960-3176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080648104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker