Provider Demographics
NPI:1881601011
Name:DEMADALER, ELYSE M (LCSW)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:M
Last Name:DEMADALER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUSAN CT
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2218
Mailing Address - Country:US
Mailing Address - Phone:845-229-0271
Mailing Address - Fax:
Practice Address - Street 1:6 SUSAN CT
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2218
Practice Address - Country:US
Practice Address - Phone:845-797-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR O437251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9L48Medicare ID - Type UnspecifiedPROVIDER NUMBER