| Doctor Name: | DR. ELIAS MICHAEL ELLOVICH |
| NPI Number: | 1043417801 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 10521 |
| Business Practice Address: | 699 Bloomfield Ave Bloomfield, CT - 060022462 |
| Business Phone Number: | 8602786355 |
| Business Fax Number: | 8602421257 |
| Mailing Address: | 699 Bloomfield Ave, BLOOMFIELD |
| State: | CT |
| Postal Code: | 060022462 |
| Phone Number: | 8602786355 |
| Fax Number: | 8602421257 |
| NPI Enumeration Date: | 06/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 10521 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |