Provider Demographics
NPI:1821245762
Name:ENISMAN, ELLYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLYN
Middle Name:
Last Name:ENISMAN
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 1:39 COLLEGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5404
Mailing Address - Country:US
Mailing Address - Phone:845-323-3835
Mailing Address - Fax:845-485-1890
Practice Address - Street 1:39 COLLEGEVIEW AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7202
Practice Address - Country:US
Practice Address - Phone:845-323-3835
Practice Address - Fax:845-485-1890
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72075571104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker