Provider Demographics
NPI:1841558954
Name:MEDUS, ELVIRA MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELVIRA
Middle Name:MARIA
Last Name:MEDUS
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 1:1 MILLIGAN PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8374
Mailing Address - Country:US
Mailing Address - Phone:773-573-8254
Mailing Address - Fax:
Practice Address - Street 1:1 MILLIGAN PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8374
Practice Address - Country:US
Practice Address - Phone:773-573-8254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079337-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical