Provider Demographics
NPI:1124049077
Name:ELZEY, MONEDIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MONEDIA
Middle Name:
Last Name:ELZEY
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 1:5036 CAMBURN RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1256
Mailing Address - Country:US
Mailing Address - Phone:484-532-7056
Mailing Address - Fax:484-532-7056
Practice Address - Street 1:5036 CAMBURN RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1256
Practice Address - Country:US
Practice Address - Phone:267-303-7365
Practice Address - Fax:484-532-7056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148341041C0700X
VA09040045671041C0700X
PAMF000438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085333Medicare ID - Type Unspecified