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General NPI Number Information
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NPI Number | 1578878583
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Entity Type | Individual
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Provider Name | ELISEE N MYRTHIL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 37 OSCEOLA ST
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City | MATTAPAN
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State | MA
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Zip | 02126-1971
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Country | US
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Telephone | 617-364-2985
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Fax | 617-910-9708
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Provider Business Mailing Address
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Address Line | 37 OSCEOAL STREET
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City | MATTAPAN
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State | MA
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Zip | 02126-1917
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | MA
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