Elishama Petersen
Individual provider Active NPI Clinical Social Worker · Wynantskill, NY
NPI 1003682287 · NPPES record last updated Nov 29, 2023
Key facts
- NPI
- 1003682287
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Practice address
- 614 Cooper Hill Rd
Wynantskill, NY 12198-2906 - Phone
- (518) 283-6500
- NPI assigned
- Nov 29, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vanderheyden Hall, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Yes |
Addresses
Primary practice location
614 Cooper Hill Rd
Wynantskill, NY 12198-2906
Mailing address
PO Box 219
Wynantskill, NY 12198-0219
Phone (518) 283-6500
Other providers in Wynantskill, NY
- Pakatar LCSW Counseling Services, PLLC
- Ritchie J Parrotta
- Scott Michael Parrotta
- Lisa M Passino
- Marie Teresa Patrignani
- Patrice Marie Pettitt
- Forman Phillips
- Jillian Picarillo
- Chantal Piche
- Leah McKenzie Pike
All providers in Wynantskill, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.