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General NPI Number Information
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NPI Number | 1154265312
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Entity Type | Individual
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Provider Name | THERESA MARIA ELLARD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 11 RUSSELL ST
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City | CAMBRIDGE
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State | MA
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Zip | 02140-1313
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Country | US
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Telephone | 866-504-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 114 GLENVILLE AVE APT 15
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City | ALLSTON
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State | MA
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Zip | 02134-3326
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Country | US
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Telephone | 866-504-9474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | MA
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