Provider Demographics
NPI:1477021632
Name:MCCUE, ELYSE TAYLOR
Entity Type:Individual
Prefix:MISS
First Name:ELYSE
Middle Name:TAYLOR
Last Name:MCCUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1145
Mailing Address - Country:US
Mailing Address - Phone:781-603-3322
Mailing Address - Fax:
Practice Address - Street 1:181 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-244-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program