Provider Demographics
NPI:1366957169
Name:REBECCA J. ELIASON LLC
Entity type:Organization
Organization Name:REBECCA J. ELIASON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:ELIASON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-416-9383
Mailing Address - Street 1:5-11 SADDLE RIVER RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5636
Mailing Address - Country:US
Mailing Address - Phone:201-416-9383
Mailing Address - Fax:
Practice Address - Street 1:5-11 SADDLE RIVER RD STE 2B
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5636
Practice Address - Country:US
Practice Address - Phone:201-416-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health