Provider Demographics
NPI:1538518493
Name:ELIEN, KETSIA
Entity type:Individual
Prefix:
First Name:KETSIA
Middle Name:
Last Name:ELIEN
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 1:1172 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4711
Mailing Address - Country:US
Mailing Address - Phone:347-961-3239
Mailing Address - Fax:718-676-6014
Practice Address - Street 1:1172 E 88TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4711
Practice Address - Country:US
Practice Address - Phone:347-961-3239
Practice Address - Fax:718-676-6014
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator