Provider Demographics
NPI:1184743551
Name:TROCK, ELISE B (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:B
Last Name:TROCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1537
Mailing Address - Country:US
Mailing Address - Phone:203-426-8103
Mailing Address - Fax:203-426-0550
Practice Address - Street 1:121 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1537
Practice Address - Country:US
Practice Address - Phone:203-426-8103
Practice Address - Fax:203-426-0550
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0024461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT77ABH0020CT01OtherANTHEM BEHAVIORAL HEALTH
CTANC1319OtherOXFORD PROVIDER PIN
CT00412586200Medicaid
CT248294OtherMHN GROUP
CT77ABH0020CT01OtherANTHEM BEHAVIORAL HEALTH