Provider Demographics
NPI:1700117173
Name:ELAHI, FERESHTE (LCSW-R, PHD)
Entity Type:Individual
Prefix:
First Name:FERESHTE
Middle Name:
Last Name:ELAHI
Suffix:
Gender:F
Credentials:LCSW-R, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W 102ND ST
Mailing Address - Street 2:#6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8400
Mailing Address - Country:US
Mailing Address - Phone:212-662-6308
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-24
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020422-1103TC0700X
NYR049618-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN21021Medicare PIN