Individual
PROF. ELISA HAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5 MEDICAL DR, PORT JEFFERSON STATION, NY 11776-1595
(631) 632-3785
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 632-3785
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
012228
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01992589
—
NY
01
—
7606588
AETNA
NY
Enumeration date
06/13/2006
Last updated
07/08/2007
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