| Elysian Group Practice Llc | |
|
133 Gertrude Ave Mamaroneck NY 10543-1506 | |
| (718) 200-3653 | |
| Not Available |
| Full Name | Elysian Group Practice Llc |
|---|---|
| Speciality | Social Worker |
| Location | 133 Gertrude Ave, Mamaroneck, New York |
| Authorized Official Name and Position | Taniesha Delph (OWNER) |
| Authorized Official Contact | 9142920524 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elysian Group Practice Llc 133 Gertrude Ave Mamaroneck NY 10543-1506 Ph: (718) 200-3653 | Elysian Group Practice Llc 133 Gertrude Ave Mamaroneck NY 10543-1506 Ph: (718) 200-3653 |
| NPI Number | 1871296772 |
|---|---|
| Provider Enumeration Date | 03/22/2023 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871296772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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