Healthcare Provider Details

I. General information

NPI: 1093774861
Provider Name (Legal Business Name): ELAINE ORABONA FOSTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE ORABONA MANTELL PH.D.

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 MARTINEZ LANE
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 594
MESILLA NM
88046-0594
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-0341
  • Fax:
Mailing address:
  • Phone: 850-865-2168
  • Fax: 575-252-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1197
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: