Provider Demographics
NPI:1235285255
Name:CHEREPANOV, ELENA (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:CHEREPANOV
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MARION ST # 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1724
Mailing Address - Country:US
Mailing Address - Phone:781-325-5449
Mailing Address - Fax:
Practice Address - Street 1:204 MARION ST # 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1724
Practice Address - Country:US
Practice Address - Phone:781-325-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health