Provider Demographics
NPI:1780016931
Name:ELSON-VICTOR, MARNI R (LPC)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:R
Last Name:ELSON-VICTOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 SUGAR MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3008
Mailing Address - Country:US
Mailing Address - Phone:732-462-8718
Mailing Address - Fax:
Practice Address - Street 1:272 SUGAR MAPLE CT
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3008
Practice Address - Country:US
Practice Address - Phone:732-462-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00473400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional