Provider Demographics
NPI:1780018481
Name:CHAIFETZ, ELYSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:
Last Name:CHAIFETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:
Other - Last Name:KUPPERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 E 41ST ST STE 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6217
Mailing Address - Country:US
Mailing Address - Phone:917-473-3086
Mailing Address - Fax:
Practice Address - Street 1:16 E 41ST ST STE 5E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6217
Practice Address - Country:US
Practice Address - Phone:917-473-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1184074866OtherILANA ROSENBERG