Basic Information
| Provider Information | |||||||||
| NPI: | 1225453293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRUAN | ||||||||
| FirstName: | MARIA ELENA | ||||||||
| MiddleName: | KATERINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 FAIRVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023592917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178164757 | ||||||||
| FaxNumber: | 7817540131 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 ROBBS HILL RD | ||||||||
| Address2: | |||||||||
| City: | LUNENBURG | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014622167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742701766 | ||||||||
| FaxNumber: | 5088610206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.