Provider Demographics
NPI:1578398384
Name:BROSSI, ELENA (MA, CAGS, LEP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BROSSI
Suffix:
Gender:F
Credentials:MA, CAGS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HANCOCK ST APT 1202
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2493
Mailing Address - Country:US
Mailing Address - Phone:508-686-6422
Mailing Address - Fax:
Practice Address - Street 1:971 CONCORD STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-686-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA529001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist