Provider Demographics
NPI:1275071904
Name:HOBLITZELLE, ELISE (LMHC, MA, M ED)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:HOBLITZELLE
Suffix:
Gender:F
Credentials:LMHC, MA, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1952
Mailing Address - Country:US
Mailing Address - Phone:617-733-2091
Mailing Address - Fax:
Practice Address - Street 1:5 UPLAND RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2717
Practice Address - Country:US
Practice Address - Phone:617-733-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000008792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional