Provider Demographics
NPI:1639754765
Name:MCELWAIN, CORA-ANN ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:CORA-ANN
Middle Name:ROSE
Last Name:MCELWAIN
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 1:170 SEARS RD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2927
Mailing Address - Country:US
Mailing Address - Phone:631-383-9468
Mailing Address - Fax:
Practice Address - Street 1:2165 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2904
Practice Address - Country:US
Practice Address - Phone:631-383-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200370201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical