Provider Demographics
NPI:1144664582
Name:ALTSCHUL, ELIOT BENJAMIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:BENJAMIN
Last Name:ALTSCHUL
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 1:727 WAINEE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1589
Mailing Address - Country:US
Mailing Address - Phone:808-661-4454
Mailing Address - Fax:
Practice Address - Street 1:727 WAINEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1589
Practice Address - Country:US
Practice Address - Phone:808-661-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist