Individual
DR. ISA L. ELIASOPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
11 GROSVENOR PL, GREAT NECK, NY 11021-4534
(516) 482-3569
Mailing address
11 GROSVENOR PL, GREAT NECK, NY 11021-4534
(516) 482-3569
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
017411
NY
103TF0000X
Family Psychologist
017411
NY
103TS0200X
School Psychologist
017411
NY
Other
Enumeration date
02/20/2008
Last updated
02/20/2008
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