Provider Demographics
NPI:1952042350
Name:LORD, ELENA CRARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:CRARY
Last Name:LORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E 62ND ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-9024
Mailing Address - Country:US
Mailing Address - Phone:917-856-1103
Mailing Address - Fax:
Practice Address - Street 1:5 E 16TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3112
Practice Address - Country:US
Practice Address - Phone:917-856-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist