Provider Demographics
NPI:1306617311
Name:KAISER, ELISA MARIE WHITE (LPCMH)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIE WHITE
Last Name:KAISER
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:MARIE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCMH
Mailing Address - Street 1:410 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-1244
Mailing Address - Country:US
Mailing Address - Phone:302-222-0981
Mailing Address - Fax:
Practice Address - Street 1:177 OLD CAMDEN RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-5500
Practice Address - Country:US
Practice Address - Phone:302-232-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health