Provider Demographics
NPI:1629145354
Name:LEIFMAN, ELLEN S (LIC AC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:LEIFMAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 EDMANDS RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3089
Mailing Address - Country:US
Mailing Address - Phone:508-788-0185
Mailing Address - Fax:
Practice Address - Street 1:639 EDMANDS RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3089
Practice Address - Country:US
Practice Address - Phone:508-788-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist