Individual
DR. ELAINE R AXELROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
123 S BROAD ST STE 2048, PHILADELPHIA, PA 19109-1051
(215) 732-5187
Mailing address
123 S BROAD ST STE 2048, PHILADELPHIA, PA 19109-1051
(215) 732-5187
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS004751L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
0
—
Enumeration date
11/16/2018
Last updated
11/16/2018
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