Provider Demographics
NPI:1205909983
Name:LEDERER, ELAINE THYPIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:THYPIN
Last Name:LEDERER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:THYPIN
Other - Last Name:LEDERER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:90 RIVERSIDE DR
Mailing Address - Street 2:11G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5306
Mailing Address - Country:US
Mailing Address - Phone:212-799-6706
Mailing Address - Fax:
Practice Address - Street 1:9729 64TH RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2240
Practice Address - Country:US
Practice Address - Phone:718-896-3400
Practice Address - Fax:718-459-5621
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0211951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY99025ZMedicare ID - Type Unspecified