Provider Demographics
NPI:1952587065
Name:TAYLOR, ELAINE RENEE (CASAC-T)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:RENEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 51ST ST
Mailing Address - Street 2:APT #6D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1329
Mailing Address - Country:US
Mailing Address - Phone:347-256-1773
Mailing Address - Fax:
Practice Address - Street 1:3176 51ST ST
Practice Address - Street 2:APT #6D
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1329
Practice Address - Country:US
Practice Address - Phone:347-256-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-21785-T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)