Healthcare Provider Details

I. General information

NPI: 1629832589
Provider Name (Legal Business Name): ELIZA HOTTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 FENN ST
PITTSFIELD MA
01201
US

IV. Provider business mailing address

18 RIVER ST
DALTON MA
01226-1820
US

V. Phone/Fax

Practice location:
  • Phone: 413-629-1182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: