Provider Demographics
NPI:1588972897
Name:MATUSOF, ELKA
Entity type:Individual
Prefix:
First Name:ELKA
Middle Name:
Last Name:MATUSOF
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 1:1505 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4542
Mailing Address - Country:US
Mailing Address - Phone:347-415-4971
Mailing Address - Fax:718-756-2059
Practice Address - Street 1:470 LEFFERTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4407
Practice Address - Country:US
Practice Address - Phone:718-735-0770
Practice Address - Fax:718-804-8930
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2183005103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool