Provider Demographics
NPI:1720536949
Name:ESCALANTE, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 BEACH 122ND ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1883
Mailing Address - Country:US
Mailing Address - Phone:760-401-0664
Mailing Address - Fax:
Practice Address - Street 1:25 CHAPEL ST STE 604
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1916
Practice Address - Country:US
Practice Address - Phone:718-630-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical