| Elysian Therapy Practice Lcsw Pllc | |
|
133 Gertrude Ave Mamaroneck NY 10543-1506 | |
| (914) 315-4550 | |
| Not Available |
| Full Name | Elysian Therapy Practice Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 133 Gertrude Ave, Mamaroneck, New York |
| Authorized Official Name and Position | Taniesha Delph (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 9143154550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elysian Therapy Practice Lcsw Pllc 133 Gertrude Ave Mamaroneck NY 10543-1506 Ph: (718) 200-3653 | Elysian Therapy Practice Lcsw Pllc 133 Gertrude Ave Mamaroneck NY 10543-1506 Ph: (914) 315-4550 |
| NPI Number | 1366223711 |
|---|---|
| Provider Enumeration Date | 10/11/2023 |
| Last Update Date | 10/17/2023 |
| Certification Date | 10/17/2023 |
| Medicare PECOS PAC ID | 2668918053 |
|---|---|
| Medicare Enrollment ID | O20240722002637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366223711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Taniesha Delph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134620388 PECOS PAC ID: 9931645330 Enrollment ID: I20240723003136 |
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