Provider Demographics
NPI:1104850619
Name:KATZ, ELYSE V (LCSW)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:V
Last Name:KATZ
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 1:515 PLAINFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2598
Mailing Address - Country:US
Mailing Address - Phone:732-777-1940
Mailing Address - Fax:732-777-1889
Practice Address - Street 1:515 PLAINFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2598
Practice Address - Country:US
Practice Address - Phone:732-777-1940
Practice Address - Fax:732-777-1889
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01305100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045608Medicaid
NJ0045608Medicaid