MEDICARE: ELIJAH RUTH FIALCO BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1285550459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIJAH RUTH FIALCO BA

Provider Business Mailing Address
First Line	:	77 WARREN ST BLDG 5
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-3601
Country	:	US
Telephone Number	:	617-782-7668
Fax Number	:	617-782-7668

Provider Business Practice Location Address
First Line	:	77 WARREN ST BLDG 2
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-3601
Country	:	US
Telephone Number	:	617-245-1271
Fax Number	:	617-782-7668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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