Basic Information
| Provider Information | |||||||||
| NPI: | 1245439645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECONOMIDES | ||||||||
| FirstName: | ELENI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TSOMPANIDOU | ||||||||
| OtherFirstName: | ELENI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 625 PANORAMA TRAIL | ||||||||
| Address2: | BLDG 1 STE 107 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854697072 | ||||||||
| FaxNumber: | 5853443047 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 PANORAMA TRAIL | ||||||||
| Address2: | BLDG 1 STE 107 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854697072 | ||||||||
| FaxNumber: | 5853443047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 000792 | NY | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.