Basic Information
| Provider Information | |||||||||
| NPI: | 1154760544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SETRAKIAN | ||||||||
| FirstName: | LENA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W HIGH ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106200008 | ||||||||
| FaxNumber: | 4106201999 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W HIGH ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106200008 | ||||||||
| FaxNumber: | 4106201999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 08/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC5067 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.