MEDICARE: ELENA USOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	XL4100	ME

General Provider Information

NPI Number	:	1316287188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA USOVA

Provider Business Mailing Address
First Line	:	71 ROUTE 1
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 PORTLAND AVE APT 7
Second Line	:
City	:	OLD ORCHARD BEACH
State	:	ME
Zip	:	04064-1527
Country	:	US
Telephone Number	:	207-286-6625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/20/2013

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Directions to “ ELENA USOVA ” Practice Location

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