Provider Demographics
NPI:1316463177
Name:ELOSKOF, GENEVIEVE (BCBA)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:ELOSKOF
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WATERSIDE PLZ APT 21E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2605
Mailing Address - Country:US
Mailing Address - Phone:714-745-9156
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD STE 105
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1210
Practice Address - Country:US
Practice Address - Phone:203-674-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24450103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty