Provider Demographics
NPI:1932439866
Name:RELLA, ELYSE MICHELLE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:ELYSE
Middle Name:MICHELLE
Last Name:RELLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ELYSE
Other - Middle Name:MICHELLE
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7812 35TH AVE
Mailing Address - Street 2:APT. 2M
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2566
Mailing Address - Country:US
Mailing Address - Phone:347-738-6798
Mailing Address - Fax:
Practice Address - Street 1:3722 82ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7032
Practice Address - Country:US
Practice Address - Phone:718-779-1600
Practice Address - Fax:718-803-0895
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker