Provider Demographics
NPI:1952651226
Name:LICHTMAN, ELIANA (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELIANA
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ELIANA
Other - Middle Name:
Other - Last Name:BLINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:149-05 79TH AVE
Mailing Address - Street 2:APT. #617
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3875
Mailing Address - Country:US
Mailing Address - Phone:818-590-1919
Mailing Address - Fax:
Practice Address - Street 1:149-05 79TH AVE
Practice Address - Street 2:APT. #617
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3875
Practice Address - Country:US
Practice Address - Phone:818-590-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist