Basic Information
| Provider Information | |||||||||
| NPI: | 1326039603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SENGHAS | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | CLEANSLATE CENTERS | ||||||||
| Address2: | 244 MAIN STREET ANNEX PO BOX 32 ATTN ANITRA PIQUE | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010610032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135842173 | ||||||||
| FaxNumber: | 4135176009 | ||||||||
| Practice Location | |||||||||
| Address1: | 76B CARLON DR | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135842178 | ||||||||
| FaxNumber: | 4135864233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 09/21/2015 | ||||||||
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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 | 207RA0000X | 57444 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000008111 | 01 | MA | BMC HEALTHNET | OTHER | 484699 | 01 | MA | CONNECTICARE | OTHER | 101484 | 01 | MA | CIGNA | OTHER | 3700017421 | 01 | MA | MEDICARE RAILROAD | OTHER | J06291 | 01 | MA | BCBS OF MASS | OTHER | 057444 | 01 | MA | TUFTS | OTHER | 7166124 | 01 | MA | AETNA | OTHER | 16315 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 201187 | 01 | MA | HARVARD PILGRIM HEALTHCAR | OTHER | 3027546 | 05 | MA | MEDICAID |