Provider Demographics
NPI:1194884007
Name:ELLIOTT, DAVID S (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 MAIN RD.
Mailing Address - Street 2:
Mailing Address - City:WESTPORT POINT
Mailing Address - State:MA
Mailing Address - Zip Code:02791-9999
Mailing Address - Country:US
Mailing Address - Phone:508-496-7401
Mailing Address - Fax:
Practice Address - Street 1:501 ANGELL ST.
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-868-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00499103TC0700X
MA4979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical