Individual
DR. MICHAEL J ELTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
340 BROADWAY, PROVIDENCE, RI 02909-1102
(401) 714-7440
(401) 489-7207
Mailing address
31 KILBURN AVE, LINCOLN, RI 02865-2129
(401) 714-7440
(401) 490-2619
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS00748
RI
251S00000X
Community/Behavioral Health Agency
PS00748
RI
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ME37214
—
RI
Enumeration date
04/06/2006
Last updated
09/25/2024
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