Provider Demographics
NPI:1457575755
Name:ELAINE KLIONSKY, J.D., PH.D., INC
Entity Type:Organization
Organization Name:ELAINE KLIONSKY, J.D., PH.D., INC
Other - Org Name:ELAINE KLIONSKY, J.D., PH.D., LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLIONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-641-8406
Mailing Address - Street 1:3629 CHEVY CHASE LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-641-8406
Mailing Address - Fax:
Practice Address - Street 1:4809 ST. ELMO AVENUE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-641-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03260103T00000X
DC1826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty