Provider Demographics
NPI:1386802791
Name:ELIOPOULOS, ELAINE M (LIC AC)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:M
Last Name:ELIOPOULOS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:70 BOSTON POST RD # R
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2422
Mailing Address - Country:US
Mailing Address - Phone:978-973-7866
Mailing Address - Fax:781-647-8341
Practice Address - Street 1:475 CONANT RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1830
Practice Address - Country:US
Practice Address - Phone:978-973-7866
Practice Address - Fax:781-647-8341
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist