Provider Demographics
NPI:1780104315
Name:AXELROD, ELANA (LCSW)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:AXELROD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELANA
Other - Middle Name:
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4906
Mailing Address - Country:US
Mailing Address - Phone:631-219-6683
Mailing Address - Fax:
Practice Address - Street 1:275 HARBOR DR
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4906
Practice Address - Country:US
Practice Address - Phone:631-219-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085475-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical