Individual
ELSIE DUME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
188 CUMBERLAND ST, MASTIC, NY 11950-4704
(516) 943-7545
Mailing address
188 CUMBERLAND ST, MASTIC, NY 11950-4704
(516) 943-7545
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
325531-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11303
—
NY
Enumeration date
10/24/2018
Last updated
10/24/2018
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