Provider Demographics
NPI:1982146429
Name:MAICHIN, ELISABETH ELAINE (MSC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ELAINE
Last Name:MAICHIN
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CLINTON PL APT 7
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1753
Mailing Address - Country:US
Mailing Address - Phone:714-768-8538
Mailing Address - Fax:
Practice Address - Street 1:122 CLINTON PL APT 7
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1753
Practice Address - Country:US
Practice Address - Phone:714-768-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ759536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health