Provider Demographics
NPI:1386696961
Name:GARLICK, ELYSE GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:GAIL
Last Name:GARLICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1304
Mailing Address - Country:US
Mailing Address - Phone:609-924-9329
Mailing Address - Fax:609-924-1256
Practice Address - Street 1:33 STATE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1304
Practice Address - Country:US
Practice Address - Phone:609-924-9329
Practice Address - Fax:609-924-1256
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004395001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ696584Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER