Individual
MR. LUKE GRISHA ELLENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.A.S.A.C.
Contact information
Practice address
134 HAVEN AVE APT 1E, NEW YORK, NY 10032-1126
(718) 869-1086
Mailing address
134 HAVEN AVE APT 1E, NEW YORK, NY 10032-1126
(718) 869-1086
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21246
NY
Other
Enumeration date
07/14/2010
Last updated
07/14/2010
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