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Individual

ELENA DEJESUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
10 BRIDGE ST, SUITE 300, LOWELL, MA 01852-1268
(978) 453-5736
Mailing address
11 LILLEY AVE APT 2, LOWELL, MA 01850
(978) 726-7832

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1000015708025
MASSHEALTH
MA
Enumeration date
09/14/2016
Last updated
09/14/2016
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