Provider Demographics
NPI:1730860727
Name:ELAD, SEAN MBENGU
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MBENGU
Last Name:ELAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 MASSACHUSETTS AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1428
Mailing Address - Country:US
Mailing Address - Phone:617-842-8028
Mailing Address - Fax:
Practice Address - Street 1:61 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5029
Practice Address - Country:US
Practice Address - Phone:617-842-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker