Provider Demographics
NPI:1992901813
Name:MESSORE, ELISA HOPE (LCSW)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:HOPE
Last Name:MESSORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 MOSHOLU AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2214
Mailing Address - Country:US
Mailing Address - Phone:917-407-2763
Mailing Address - Fax:
Practice Address - Street 1:123-125 WEST. 124TH STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-531-1300
Practice Address - Fax:212-849-2786
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY92862151041C0700X
NY0704401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical