MEDICARE: ELEANOR HEALTH PROFESSIONAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	207QA0401X	Addiction Medicine (Family Medicine) Physician
3	2084P0800X	Psychiatry Physician
4	2084P0802X	Addiction Psychiatry Physician

General Provider Information

NPI Number	:	1467327155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEANOR HEALTH PROFESSIONAL

Provider Business Mailing Address
First Line	:	PO BOX 386
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03802-0386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 E CARSON AVE STE 1033
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-5909
Country	:	US
Telephone Number	:	781-487-1107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NZINGA AJABU HARRISON
Credential	:
Telephone Number	:	617-419-0858

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	10/10/2025

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Directions to “ELEANOR HEALTH PROFESSIONAL ” Practice Location

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