Provider Demographics
NPI:1710353230
Name:NEPA, ELYSE (MSED)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:NEPA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 RIVER VIEW RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1126
Mailing Address - Country:US
Mailing Address - Phone:518-530-7207
Mailing Address - Fax:
Practice Address - Street 1:401 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3840
Practice Address - Country:US
Practice Address - Phone:518-426-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health