Provider Demographics
NPI:1487143293
Name:MAYA, ELISA (MSED, TSHH)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:MAYA
Suffix:
Gender:F
Credentials:MSED, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 VETERANS HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2940
Mailing Address - Country:US
Mailing Address - Phone:631-851-9486
Mailing Address - Fax:
Practice Address - Street 1:888 VETERANS HWY STE 310
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2940
Practice Address - Country:US
Practice Address - Phone:631-851-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst