Provider Demographics
NPI:1346050143
Name:GONCALVES, ELIANA
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BUCKLEY RD # 624
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1526
Mailing Address - Country:US
Mailing Address - Phone:857-588-3056
Mailing Address - Fax:
Practice Address - Street 1:12 BUCKLEY RD # 624
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1526
Practice Address - Country:US
Practice Address - Phone:857-588-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician