Provider Demographics
NPI:1689428484
Name:DENNIS, ELISA MARIE
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:MARIE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELISA
Other - Middle Name:MARIE
Other - Last Name:DAMIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:627 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1525
Mailing Address - Country:US
Mailing Address - Phone:570-766-1043
Mailing Address - Fax:
Practice Address - Street 1:116 LARCH ST FL 3
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2802
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency