Provider Demographics
NPI:1619286259
Name:ELDERKIN, TINA MACHADO
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MACHADO
Last Name:ELDERKIN
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 1:23 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769
Mailing Address - Country:US
Mailing Address - Phone:774-991-2138
Mailing Address - Fax:
Practice Address - Street 1:23 BROAD ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1216
Practice Address - Country:US
Practice Address - Phone:177-499-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
STUDENT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst