Healthcare Provider Details

I. General information

NPI: 1275071904
Provider Name (Legal Business Name): ELISE HOBLITZELLE LMHC, MA, M ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 UPLAND RD
CAMBRIDGE MA
02140-2717
US

IV. Provider business mailing address

64 LINCOLN ST
WATERTOWN MA
02472-1952
US

V. Phone/Fax

Practice location:
  • Phone: 617-733-2091
  • Fax:
Mailing address:
  • Phone: 617-733-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000008792
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: