Provider Demographics
NPI:1790759249
Name:SKLAROFF, ELISSA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:
Last Name:SKLAROFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 PENNA AVE
Mailing Address - Street 2:#7047
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3077
Mailing Address - Country:US
Mailing Address - Phone:215-765-8288
Mailing Address - Fax:610-896-4220
Practice Address - Street 1:2401 PENNA AVE
Practice Address - Street 2:#7047
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3077
Practice Address - Country:US
Practice Address - Phone:215-765-8288
Practice Address - Fax:610-896-4220
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002436L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical