Provider Demographics
NPI:1306979224
Name:BAUER, ELENA
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:
Last Name:BAUER
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 1:2166 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:APARTMENT 4-O
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2002
Mailing Address - Country:US
Mailing Address - Phone:646-709-8642
Mailing Address - Fax:
Practice Address - Street 1:150 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7802
Practice Address - Country:US
Practice Address - Phone:646-709-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000641-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis