Provider Demographics
NPI:1336783224
Name:ELKIN, REBECCA (LCAT, RDT, MA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ELKIN
Suffix:
Gender:F
Credentials:LCAT, RDT, MA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ELKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:243 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2334
Practice Address - Country:US
Practice Address - Phone:716-316-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1761101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Single Specialty