Provider Demographics
NPI:1770675662
Name:ELSMAN, DEBRA (MS)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:ELSMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:ELSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:510 S BATAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2902
Mailing Address - Country:US
Mailing Address - Phone:630-879-3020
Mailing Address - Fax:
Practice Address - Street 1:201 HOUSTON ST STE 302
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1980
Practice Address - Country:US
Practice Address - Phone:630-879-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL166000160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180001645OtherLICENSED CLINICAL COUNSEL