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NPI Code Detail

MEDICARE: MRS. ELISABETH DRAKE M.A., PSYS.

MEDICARE: MRS. ELISABETH DRAKE M.A., PSYS.
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
1103TS0200XSchool Psychologist52715457MA

General Provider Information

NPI Number : 1932611233
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELISABETH DRAKE M.A., PSYS.
Provider Business Mailing Address
First Line : 40 ARMINGTON ST
Second Line :
City : ALLSTON
State : MA
Zip : 02134-2406
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 40 ARMINGTON ST
Second Line :
City : ALLSTON
State : MA
Zip : 02134-2406
Country : US
Telephone Number : 617-635-8544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2017
Last Update Date : 10/27/2017

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