Provider Demographics
NPI:1518441450
Name:EISAN-SMITH, MICHELLE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:E
Last Name:EISAN-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1511
Mailing Address - Country:US
Mailing Address - Phone:617-206-4413
Mailing Address - Fax:
Practice Address - Street 1:452 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1511
Practice Address - Country:US
Practice Address - Phone:617-206-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA491922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical