Provider Demographics
NPI:1932312113
Name:MCQUILLAN, ELAINE M (LCSW CASAC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:MCQUILLAN
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:M
Other - Last Name:SOLJANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW CASAC
Mailing Address - Street 1:119 LAKEBRIDGE DR NORTH
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-544-4638
Mailing Address - Fax:
Practice Address - Street 1:NORTH COUNTY COMPLEX CLINIC YOUTH ADULT PROGRAM
Practice Address - Street 2:BLDG 151
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-6340
Practice Address - Fax:631-853-6338
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0500181104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker