Provider Demographics
NPI:1356418073
Name:TRACHTENBERG, ELISHEVA D (LMSW)
Entity type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:D
Last Name:TRACHTENBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MEEHAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5429
Mailing Address - Country:US
Mailing Address - Phone:718-471-7657
Mailing Address - Fax:
Practice Address - Street 1:526 MEEHAN AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5429
Practice Address - Country:US
Practice Address - Phone:718-471-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07178311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical