Individual
ITAMAR ELIZALDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
172 LINCOLN ST, WORCESTER, MA 01605-3750
(508) 770-0511
(508) 770-0875
Mailing address
43 CLEVELAND AVE, WORCESTER, MA 01603-1404
(508) 757-0582
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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