Provider Demographics
NPI:1891371415
Name:PERSING, ELI N
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:N
Last Name:PERSING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 OLD TANEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3531
Mailing Address - Country:US
Mailing Address - Phone:240-298-6823
Mailing Address - Fax:
Practice Address - Street 1:2651 OLD TANEYTOWN RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-3531
Practice Address - Country:US
Practice Address - Phone:240-298-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker