Provider Demographics
NPI:1982593737
Name:DAVILA FERNANDEZ, ELIS CRISTINA (MHC)
Entity type:Individual
Prefix:DR
First Name:ELIS
Middle Name:CRISTINA
Last Name:DAVILA FERNANDEZ
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E 96TH ST APT 15D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0777
Mailing Address - Country:US
Mailing Address - Phone:917-363-2808
Mailing Address - Fax:
Practice Address - Street 1:65 E 96TH ST APT 15D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0777
Practice Address - Country:US
Practice Address - Phone:917-363-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY1733995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty