Provider Demographics
NPI:1790093185
Name:WEINSTEIN, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:WEINSTEIN
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 1:180 LAFAYETTE AVE APT 7J
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4741
Mailing Address - Country:US
Mailing Address - Phone:469-693-5374
Mailing Address - Fax:
Practice Address - Street 1:180 LAFAYETTE AVE APT 7J
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4741
Practice Address - Country:US
Practice Address - Phone:469-693-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst