Provider Demographics
NPI:1093774861
Name:FOSTER, ELAINE ORABONA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:ORABONA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:ORABONA
Other - Last Name:MANTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:MESILLA
Mailing Address - State:NM
Mailing Address - Zip Code:88046-0594
Mailing Address - Country:US
Mailing Address - Phone:850-865-2168
Mailing Address - Fax:575-252-6132
Practice Address - Street 1:2488 CALLE DE GUADALUPE
Practice Address - Street 2:
Practice Address - City:MESILLA
Practice Address - State:NM
Practice Address - Zip Code:88046-0594
Practice Address - Country:US
Practice Address - Phone:575-323-0341
Practice Address - Fax:575-252-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0021103TP0016X
NM1197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical