Provider Demographics
NPI:1659077477
Name:ABREU, ELAN ADINA (MSW)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:ADINA
Last Name:ABREU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ONEIL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3512
Mailing Address - Country:US
Mailing Address - Phone:845-389-4789
Mailing Address - Fax:
Practice Address - Street 1:122 ONEIL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3512
Practice Address - Country:US
Practice Address - Phone:845-389-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117437-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY117437-01OtherUNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT