Provider Demographics
NPI:1952330045
Name:ELASSAD, LINDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:ELASSAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 WOOLLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2094
Mailing Address - Country:US
Mailing Address - Phone:718-987-2225
Mailing Address - Fax:
Practice Address - Street 1:201 BRYSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1922
Practice Address - Country:US
Practice Address - Phone:718-987-2225
Practice Address - Fax:718-987-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247432OtherVALUE OPTION
NY22708POtherHIP
NYP3395236OtherOXFORD
NY7337124OtherGHI
NY02218766Medicaid
NY7337124OtherGHI