Provider Demographics
NPI:1174814875
Name:MACK, ELAINE A (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:A
Last Name:MACK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8657
Mailing Address - Country:US
Mailing Address - Phone:413-822-0402
Mailing Address - Fax:413-464-9553
Practice Address - Street 1:15 ALMA ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8657
Practice Address - Country:US
Practice Address - Phone:413-822-0402
Practice Address - Fax:413-464-9553
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5245173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist