Provider Demographics
NPI:1871983981
Name:GREENBAUM, ELYSE AMEDEO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:AMEDEO
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELYSE
Other - Middle Name:SARA
Other - Last Name:AMEDEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MOUNT BETHEL RD # 269
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5604
Mailing Address - Country:US
Mailing Address - Phone:732-507-5319
Mailing Address - Fax:
Practice Address - Street 1:409 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2526
Practice Address - Country:US
Practice Address - Phone:732-507-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056179001041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool