Provider Demographics
NPI:1710162847
Name:HAHN FELIX, ELISE (LCSW, MSWAC)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:
Last Name:HAHN FELIX
Suffix:
Gender:F
Credentials:LCSW, MSWAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0055
Mailing Address - Country:US
Mailing Address - Phone:516-546-1771
Mailing Address - Fax:151-662-3588
Practice Address - Street 1:950 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4223
Practice Address - Country:US
Practice Address - Phone:516-546-1771
Practice Address - Fax:516-623-5880
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027981-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02772512Medicaid