1861504953 NPI number — MISS ELAINE SUSAN CANTONE LMHC

Table of content: MISS ELAINE SUSAN CANTONE LMHC (NPI 1861504953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861504953 NPI number — MISS ELAINE SUSAN CANTONE LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTONE
Provider First Name:
ELAINE
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861504953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W CUMMINGS PARK
Provider Second Line Business Mailing Address:
SUITE 3200
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-6372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-937-5678
Provider Business Mailing Address Fax Number:
781-937-5678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W CUMMINGS PARK
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-937-5678
Provider Business Practice Location Address Fax Number:
781-937-5678
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  5029 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 469602 . This is a "HMO TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 01550050201 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: LM0974 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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