Healthcare Provider Details

I. General information

NPI: 1588416648
Provider Name (Legal Business Name): ELENA RACHEL STEIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1048
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1048
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-3448
  • Fax:
Mailing address:
  • Phone: 617-855-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10000863
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: