Provider Demographics
NPI:1720297062
Name:BERON, ELISABETH MAE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:MAE
Last Name:BERON
Suffix:
Gender:F
Credentials:PSY D
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Mailing Address - Street 1:98 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5323
Mailing Address - Country:US
Mailing Address - Phone:212-712-9441
Mailing Address - Fax:212-712-9441
Practice Address - Street 1:98 RIVERSIDE DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5323
Practice Address - Country:US
Practice Address - Phone:212-712-9441
Practice Address - Fax:212-712-9441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical