Healthcare Provider Details

I. General information

NPI: 1710619796
Provider Name (Legal Business Name): ELIZA TEMPLET ABOURAAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

86 SEMINOLE RD
ACTON MA
01720-2523
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2277158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: