Provider Demographics
NPI:1720892854
Name:VIELE, ELISSA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:MARIE
Last Name:VIELE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PENBROOKE DR STE 2K
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2042
Mailing Address - Country:US
Mailing Address - Phone:585-377-6470
Mailing Address - Fax:
Practice Address - Street 1:401 PENBROOKE DR STE 2K
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2042
Practice Address - Country:US
Practice Address - Phone:585-377-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072156-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker