Provider Demographics
NPI:1285878041
Name:BARDAVID, ELLIOT (LCSW)
Entity type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:
Last Name:BARDAVID
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20939 23RD AVE
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1844
Mailing Address - Country:US
Mailing Address - Phone:917-767-7604
Mailing Address - Fax:
Practice Address - Street 1:20939 23RD AVE
Practice Address - Street 2:SUITE 6A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1844
Practice Address - Country:US
Practice Address - Phone:917-767-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018951-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical