Provider Demographics
NPI:1700914637
Name:TAKAHASHI, ELAINE ACHE (LCSW MSW)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ACHE
Last Name:TAKAHASHI
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HENNESSY ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641
Mailing Address - Country:US
Mailing Address - Phone:201-384-7745
Mailing Address - Fax:
Practice Address - Street 1:350 HENNESSY ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641
Practice Address - Country:US
Practice Address - Phone:201-384-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002835001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
039108Medicare ID - Type Unspecified