Provider Demographics
NPI:1780912295
Name:ELISH, HARRIET L (LCSW)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:L
Last Name:ELISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BROWNLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1439
Mailing Address - Country:US
Mailing Address - Phone:860-233-0256
Mailing Address - Fax:
Practice Address - Street 1:337 VINE ST
Practice Address - Street 2:EBONY HORSEWOMEN
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2028
Practice Address - Country:US
Practice Address - Phone:860-293-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical