Provider Demographics
NPI:1154777845
Name:SHOMRON-ATAR, EILON NATHAN
Entity type:Individual
Prefix:
First Name:EILON
Middle Name:NATHAN
Last Name:SHOMRON-ATAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FRONT ST STE C
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6665
Mailing Address - Country:US
Mailing Address - Phone:347-674-9532
Mailing Address - Fax:
Practice Address - Street 1:33 FRONT ST STE C
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6665
Practice Address - Country:US
Practice Address - Phone:347-674-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEPS1576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program