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DR. MARK RANDOLPH ELIN PH.D.

Clinical Neuropsychologist

Longmeadow, Massachusetts

Provider NPI: 1366460891

Provider Information:
DR. MARK RANDOLPH ELIN PH.D.
Gender: M
Sole Proprietor


Practice Location:
1200 CONVERSE ST SUITE 102 LONGMEADOW, MA 01106 US
Tel: 413-567-9244  Fax: --

Business Mailing Address:
1200 CONVERSE ST SUITE 102 LONGMEADOW, MA 01106 US
Tel: 413-567-9244  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
MA4026

Other Provider Identifiers:

IssuerNumberStateType
0522589MA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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