Provider Demographics
NPI:1285811331
Name:SQUERI, ELAINE (LPN,MA,CASAC)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:SQUERI
Suffix:
Gender:F
Credentials:LPN,MA,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1217
Mailing Address - Country:US
Mailing Address - Phone:516-374-3671
Mailing Address - Fax:516-374-3671
Practice Address - Street 1:112 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1217
Practice Address - Country:US
Practice Address - Phone:516-374-3671
Practice Address - Fax:516-374-3671
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111292-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse