Individual
ELICIA LAUREN RAVELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11 BRADSTREET AVE, BOSTON, MA 02131-3823
(617) 792-4494
Mailing address
11 BRADSTREET AVE, BOSTON, MA 02131-3823
(617) 792-4494
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
4030878
MA
Other
Enumeration date
05/20/2010
Last updated
05/20/2010
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