Provider Demographics
NPI:1891883336
Name:YOOS, ELYSSA JODI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELYSSA
Middle Name:JODI
Last Name:YOOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ELYSSA
Other - Middle Name:JODI
Other - Last Name:KRIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:47 MOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2341
Mailing Address - Country:US
Mailing Address - Phone:631-366-0530
Mailing Address - Fax:
Practice Address - Street 1:645 COMMACK RD
Practice Address - Street 2:SUITE #3
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5401
Practice Address - Country:US
Practice Address - Phone:631-543-8877
Practice Address - Fax:631-543-8886
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR056396-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical