Provider Demographics
NPI:1174394597
Name:ELBEL, JACQUELYN (PHD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:ELBEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 ROUTE 44 STE F
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-8040
Mailing Address - Country:US
Mailing Address - Phone:845-279-5908
Mailing Address - Fax:
Practice Address - Street 1:2510 ROUTE 44 STE F
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8040
Practice Address - Country:US
Practice Address - Phone:845-808-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026076103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical