Provider Demographics
NPI:1831451624
Name:MCGUIRE, ELYSE DANIELLE
Entity type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:DANIELLE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:DANIELLE
Other - Last Name:CUTRONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4547
Mailing Address - Country:US
Mailing Address - Phone:631-987-8483
Mailing Address - Fax:
Practice Address - Street 1:920 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4547
Practice Address - Country:US
Practice Address - Phone:631-987-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2131480174400000X
NY000440-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist