Provider Demographics
NPI:1043389695
Name:FAUNCE, ELAINE E (PH D)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:E
Last Name:FAUNCE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FEDERAL ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:07920-3801
Mailing Address - Country:US
Mailing Address - Phone:978-744-8070
Mailing Address - Fax:089-744-8070
Practice Address - Street 1:30 FEDERAL ST
Practice Address - Street 2:STE 101
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:07920-3801
Practice Address - Country:US
Practice Address - Phone:978-744-8070
Practice Address - Fax:089-744-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3509103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03541OtherBC BS
1012860OtherFCH FALLON COM HLTH
459415000OtherMAGELLAN BCH
MAW03541OtherBC BS