Provider Demographics
NPI:1891096541
Name:BLACK, ELAINE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1238
Mailing Address - Country:US
Mailing Address - Phone:914-882-6843
Mailing Address - Fax:
Practice Address - Street 1:71 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1238
Practice Address - Country:US
Practice Address - Phone:914-882-6843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036271103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst