Provider Demographics
NPI:1629143771
Name:KLUGMAN, ELANA (MSW)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:KLUGMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 KETTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9522
Mailing Address - Country:US
Mailing Address - Phone:413-548-9793
Mailing Address - Fax:
Practice Address - Street 1:13 OLD SOUTH ST STE 1E
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3870
Practice Address - Country:US
Practice Address - Phone:413-584-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10183531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA327560OtherMHN
MAP06452OtherBLUE CROSS BLUE SHIELD MA
MA11896OtherCIGNA
MA104404OtherMAGELLAN BEHAVIORAL HEALT
MAKLP06452Medicare ID - Type Unspecified