Provider Demographics
NPI:1942815162
Name:HOLDER-ELCOCK, ELEANOR LEANNA
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:LEANNA
Last Name:HOLDER-ELCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3126
Mailing Address - Country:US
Mailing Address - Phone:908-731-0953
Mailing Address - Fax:
Practice Address - Street 1:1326 LAKE ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3126
Practice Address - Country:US
Practice Address - Phone:908-731-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor