Provider Demographics
NPI:1841474129
Name:ANSELMI, ELVIRA (PHD)
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:ANSELMI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SUMMIT AVENUE, STE. 1
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2813
Mailing Address - Country:US
Mailing Address - Phone:201-400-4972
Mailing Address - Fax:
Practice Address - Street 1:151 SUMMIT AVENUE, STE. 1
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2813
Practice Address - Country:US
Practice Address - Phone:201-400-4972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-23
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00388800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical