Provider Demographics
NPI:1699987305
Name:SCHWARTZ, ELINA (RD, PMHNP)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RD, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FARMSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2012
Mailing Address - Country:US
Mailing Address - Phone:860-570-0569
Mailing Address - Fax:
Practice Address - Street 1:98 MAIN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-276-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2021-05-10
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2021-04-28
Provider Licenses
StateLicense IDTaxonomies
CT750133V00000X
CT819916133V00000X
CT9594363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered