Provider Demographics
NPI:1316584097
Name:TUFFY, ELISA S (NCC)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:S
Last Name:TUFFY
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTHERN BLVD # 112
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-9800
Mailing Address - Country:US
Mailing Address - Phone:570-351-4630
Mailing Address - Fax:272-207-2506
Practice Address - Street 1:790 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8799
Practice Address - Country:US
Practice Address - Phone:570-351-4630
Practice Address - Fax:272-207-2506
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health