=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326230152
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE CAMILLE CAHILL LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2007
-----------------------------------------------------
Last Update Date | 08/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 MILLBURY ST
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01501-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-832-9691
-----------------------------------------------------
Fax | 508-832-7670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 CLUBHOUSE WAY
-----------------------------------------------------
City | SUTTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01590-2443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-865-1650
-----------------------------------------------------
Fax | 508-832-7670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4339
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------