Provider Demographics
NPI:1831738731
Name:LAKS, ELISHEVA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ELISHEVA
Middle Name:
Last Name:LAKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7159 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3241
Mailing Address - Country:US
Mailing Address - Phone:646-383-3009
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4914
Practice Address - Country:US
Practice Address - Phone:718-793-3133
Practice Address - Fax:718-793-2023
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107079104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker