Provider Demographics
NPI:1194125187
Name:SELLERS, ELYSE
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 DOBBS FERRY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1916
Mailing Address - Country:US
Mailing Address - Phone:914-831-0941
Mailing Address - Fax:
Practice Address - Street 1:280 DOBBS FERRY RD
Practice Address - Street 2:STE 101
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1916
Practice Address - Country:US
Practice Address - Phone:914-831-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0843921041C0700X
NY0879591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical