Eleanor Gardner Elkin, LICSW

Key facts

NPI

1962573642

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

License

106080 (MA)

Practice address

76 Bedford St
Suite 26
Lexington, MA 02420-4646

Phone

(781) 861-1033

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962573642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 BROOKWOOD RD",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024202107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 BEDFORD ST",
            "address_2": "SUITE 26",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204646",
            "telephone_number": "781-861-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKIN",
        "first_name": "ELEANOR",
        "middle_name": "GARDNER",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "106080",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NH",
            "license": "849",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

• Eliot Community Human Services
• Eliot Community Human Services
• Eliot Community Human Services, Inc.
• Eliot Community Human Services, Inc.
• Barry Steven Elkin, PH.D
• Madeline Elizabeth Ellis
• Jenice Amy Ely, PH.D.
• Emerald Home Care, Inc.
• Lauren Emery
• Empowered Behavioral Health, LLC

All providers in Lexington, MA · Mental Health Counselor in Massachusetts