Provider Demographics
NPI:1578706826
Name:MAVROUDHIS, ATHINA-ELENI GOUDANAS (PHD)
Entity type:Individual
Prefix:
First Name:ATHINA-ELENI
Middle Name:GOUDANAS
Last Name:MAVROUDHIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST STE 27A
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2080
Mailing Address - Country:US
Mailing Address - Phone:781-690-6635
Mailing Address - Fax:617-249-0333
Practice Address - Street 1:266 MAIN ST STE 27A
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2080
Practice Address - Country:US
Practice Address - Phone:781-690-6635
Practice Address - Fax:617-249-0333
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health