Provider Demographics
NPI:1063745875
Name:AXELMAN, ELAINE B, (MA)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:B,
Last Name:AXELMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:AXELMAN
Other - Last Name:BROUDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:825 CHAUNCEY RD
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1303
Mailing Address - Country:US
Mailing Address - Phone:610-664-2560
Mailing Address - Fax:
Practice Address - Street 1:825 CHAUNCEY RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1303
Practice Address - Country:US
Practice Address - Phone:610-664-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS00608L323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA84148OtherBLUE CROSS