Provider Demographics
NPI:1801062419
Name:YUDKOVITZ, ELAINE (PHD,LCSW)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:YUDKOVITZ
Suffix:
Gender:F
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W 21ST ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6907
Mailing Address - Country:US
Mailing Address - Phone:212-989-3689
Mailing Address - Fax:212-989-3689
Practice Address - Street 1:48 W 21ST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6907
Practice Address - Country:US
Practice Address - Phone:212-989-3689
Practice Address - Fax:212-989-3689
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO293921041C0700X
NY001186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist