Basic Information
| Provider Information | |||||||||
| NPI: | 1013217223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELBERTH | ||||||||
| FirstName: | MARYANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 MARYANN LANE | ||||||||
| Address2: | |||||||||
| City: | OTISVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453864669 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST ROAD | ||||||||
| Address2: | B13, RM 131 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2010 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 016449 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.