Provider Demographics
NPI:1720709769
Name:ELISSA ISRAEL, LLC
Entity Type:Organization
Organization Name:ELISSA ISRAEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-785-9559
Mailing Address - Street 1:2211 WASHINGTON AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2620
Mailing Address - Country:US
Mailing Address - Phone:301-785-9559
Mailing Address - Fax:
Practice Address - Street 1:2211 WASHINGTON AVE APT 301
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2620
Practice Address - Country:US
Practice Address - Phone:301-785-9559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty