Individual
DR. MARK RANDOLPH ELIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1200 CONVERSE ST, SUITE 102, LONGMEADOW, MA 01106-1760
(413) 567-9244
Mailing address
1200 CONVERSE ST, SUITE 102, LONGMEADOW, MA 01106-1760
(413) 567-9244
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
4026
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0522589
—
MA
Enumeration date
07/17/2006
Last updated
07/08/2007
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