Provider Demographics
NPI:1215106141
Name:YENNACO, ELIZABETH CLAIRE ECKHARDT
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE ECKHARDT
Last Name:YENNACO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLAIRE ECKHARDT
Other - Last Name:YENNACO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, LCMT, CHT
Mailing Address - Street 1:30 RONALD DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2924
Mailing Address - Country:US
Mailing Address - Phone:781-856-1004
Mailing Address - Fax:
Practice Address - Street 1:35 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-6245
Practice Address - Country:US
Practice Address - Phone:781-856-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-0657-MT172M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172M00000XOther Service ProvidersMechanotherapist