Provider Demographics
NPI:1013088475
Name:ELIAS, SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:ELIAS
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 1:201 E 83RD ST
Mailing Address - Street 2:APT#11B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2851
Mailing Address - Country:US
Mailing Address - Phone:212-879-7490
Mailing Address - Fax:
Practice Address - Street 1:201 E 83RD ST
Practice Address - Street 2:APT#11B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2851
Practice Address - Country:US
Practice Address - Phone:212-879-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR023475-11041C0700X
NJ44C014693001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP706566OtherOXFORD PROVIDER ID
NYP706566OtherOXFORD PROVIDER ID