Provider Demographics
NPI:1902896574
Name:COUNSELMAN, ELEANOR (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:COUNSELMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CRESTVIEW RD.
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2108
Mailing Address - Country:US
Mailing Address - Phone:617-484-1179
Mailing Address - Fax:617-489-5783
Practice Address - Street 1:67 LEONARD ST STE 2
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2523
Practice Address - Country:US
Practice Address - Phone:617-484-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist