Healthcare Provider Details

I. General information

NPI: 1437666112
Provider Name (Legal Business Name): NANCY ELLIOT TOELLNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LONG POND RD STE 2&3
PLYMOUTH MA
02360-2663
US

IV. Provider business mailing address

116 LONG POND RD STE 2&3
PLYMOUTH MA
02360-2663
US

V. Phone/Fax

Practice location:
  • Phone: 774-773-3905
  • Fax:
Mailing address:
  • Phone: 774-773-3905
  • 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: