Provider Demographics
NPI:1902914831
Name:RAPOPORT, ELLIOT J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:J
Last Name:RAPOPORT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1828
Mailing Address - Country:US
Mailing Address - Phone:505-983-3757
Mailing Address - Fax:505-982-3300
Practice Address - Street 1:301 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1828
Practice Address - Country:US
Practice Address - Phone:505-983-3757
Practice Address - Fax:505-982-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMBPE 225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
201008088OtherPRESBYTERIAN HEALTH PLAN
N915OtherBCBS
R13337Medicare UPIN