Basic Information
| Provider Information | |||||||||
| NPI: | 1730156555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALEM | ||||||||
| FirstName: | ELIA | ||||||||
| MiddleName: | AWWAD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOSTON HEALTH CARE | ||||||||
| Address2: | STE 15 | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086607949 | ||||||||
| FaxNumber: | 5086607943 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 MAIN ST STE 15 | ||||||||
| Address2: | |||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 5285 | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.