Individual
KEITH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 WARD ST, SOMERVILLE, MA 02143-4214
(617) 629-6790
Mailing address
40 LOCKE ST UNIT 525, HAVERHILL, MA 01830-5503
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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