Provider Demographics
NPI:1457075384
Name:KRISEMAN, ELEANOR JANE
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:JANE
Last Name:KRISEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 CUMBERLAND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1511
Mailing Address - Country:US
Mailing Address - Phone:813-362-7082
Mailing Address - Fax:
Practice Address - Street 1:371 CUMBERLAND ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1511
Practice Address - Country:US
Practice Address - Phone:813-362-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0941111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical