=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821349119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL ELKIN LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2012
-----------------------------------------------------
Last Update Date | 09/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 WASHINGTON ST SUITE 322
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-740-3777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 PROSPECT ST.
-----------------------------------------------------
City | MARBLEHEAD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01945-3171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-631-4417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 173
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------