Provider Demographics
NPI:1023631165
Name:GIOTIS, ELISSA
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:GIOTIS
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 1:15 DURHAMOC LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3007
Mailing Address - Country:US
Mailing Address - Phone:631-617-7241
Mailing Address - Fax:
Practice Address - Street 1:15 DURHAMOC LN
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3007
Practice Address - Country:US
Practice Address - Phone:631-617-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-23
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050362-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical