Provider Demographics
NPI:1831573377
Name:ELSA ENTERPRISES PC
Entity type:Organization
Organization Name:ELSA ENTERPRISES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EARNESTINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:856-296-2825
Mailing Address - Street 1:307B MITTEN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3173
Mailing Address - Country:US
Mailing Address - Phone:856-296-2825
Mailing Address - Fax:
Practice Address - Street 1:307B MITTEN LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3173
Practice Address - Country:US
Practice Address - Phone:856-296-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO45708001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty