Provider Demographics
NPI:1760449318
Name:ELISCU, DAVID (MS, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ELISCU
Suffix:
Gender:M
Credentials:MS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COURT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6922
Mailing Address - Country:US
Mailing Address - Phone:203-848-0606
Mailing Address - Fax:203-624-6738
Practice Address - Street 1:200 ORCHARD STREET,
Practice Address - Street 2:SUITE 301 SCRANTON PROFESSIONAL CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-848-0606
Practice Address - Fax:203-624-6738
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004902101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00424565200OtherBC FAMILY PLAN
CT140004902CT01OtherANTHEM BC/BS
CT140004902CT04OtherBC/BS
CT800004130Medicare PIN