Provider Demographics
NPI:1144336868
Name:DINITZ, ELAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:DINITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 EIDER HILL CT
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4030
Mailing Address - Country:US
Mailing Address - Phone:516-625-1057
Mailing Address - Fax:516-625-6226
Practice Address - Street 1:142 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2056
Practice Address - Country:US
Practice Address - Phone:516-621-0618
Practice Address - Fax:516-625-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004184103T00000X, 103TS0200X
103TB0200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0087218OtherGHI
NY100520OtherVALUE OPTIONS
NYAA00310OtherMDNY
NYM14060Medicaid
NYR51350Medicare UPIN
NY0087218OtherGHI