Healthcare Provider Details

I. General information

NPI: 1699494450
Provider Name (Legal Business Name): ELISA HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ARLINGTON ST
NEWTON MA
02458-2424
US

IV. Provider business mailing address

WINCH PARK, 115 A ST
FRAMINGHAM MA
01701
US

V. Phone/Fax

Practice location:
  • Phone: 646-597-3240
  • Fax:
Mailing address:
  • Phone: 508-620-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: