Provider Demographics
NPI:1427615822
Name:KAGAN, ELANA RACHEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ELANA
Middle Name:RACHEL
Last Name:KAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BEACON ST APT 203
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4379
Mailing Address - Country:US
Mailing Address - Phone:203-815-7741
Mailing Address - Fax:
Practice Address - Street 1:151 MERRIMAC ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4714
Practice Address - Country:US
Practice Address - Phone:203-815-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist