Provider Demographics
NPI:1710398276
Name:KREIMENDAHL, ELYSSA JOY (MA, LCAT, LPC)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:JOY
Last Name:KREIMENDAHL
Suffix:
Gender:F
Credentials:MA, LCAT, LPC
Other - Prefix:
Other - First Name:ELYSSA
Other - Middle Name:JOY
Other - Last Name:KILMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 KERMIT PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1810
Mailing Address - Country:US
Mailing Address - Phone:646-496-8240
Mailing Address - Fax:
Practice Address - Street 1:35 KERMIT PL APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1810
Practice Address - Country:US
Practice Address - Phone:646-496-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2416101YM0800X, 101YP2500X
NY001532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional