Organization Name: | DANA ELLSMORE |
NPI Number: | 1013283134 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANA H. ELLSMORE (CLINICIAN) |
Mailing Address: | 260 Beacon St Somerville |
State: | MA US |
Postal Code: | 021433534 |
Phone Number: | 6176615700 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2012 |
NPI Last Update Date: | 03/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |