Provider Demographics
NPI:1447678461
Name:LEBRON, ELYSA LOIS (LCSW)
Entity type:Individual
Prefix:
First Name:ELYSA
Middle Name:LOIS
Last Name:LEBRON
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 1:29 BARSTOW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2222
Mailing Address - Country:US
Mailing Address - Phone:516-384-6470
Mailing Address - Fax:
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:SUITE 106
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2222
Practice Address - Country:US
Practice Address - Phone:516-384-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO72270-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical