Healthcare Provider Details

I. General information

NPI: 1831026293
Provider Name (Legal Business Name): LAURA GENEVIEVE ELLIS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 LONGMEADOW ST
LONGMEADOW MA
01106-2292
US

IV. Provider business mailing address

17 LORRAINE RD
WESTWOOD MA
02090-1039
US

V. Phone/Fax

Practice location:
  • Phone: 781-366-7020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: