Healthcare Provider Details

I. General information

NPI: 1689694564
Provider Name (Legal Business Name): ELIZABETH B GELFAND ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DAMONMILL SQ SUITE 3-1A
CONCORD MA
01742-2858
US

IV. Provider business mailing address

9 DAMONMILL SQ SUITE 3-1A
CONCORD MA
01742-2858
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-0008
  • Fax: 978-456-6823
Mailing address:
  • Phone: 978-287-0008
  • Fax: 978-456-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: