Provider Demographics
NPI:1780085605
Name:ELIE, THERESA NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:NICOLE
Last Name:ELIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:NICOLE
Other - Last Name:RICHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:227 THORN AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2600
Practice Address - Country:US
Practice Address - Phone:716-882-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904881041C0700X
NY0923331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical