Provider Demographics
NPI:1689188039
Name:ESTRELLA, ELICIA ANN (MS, CGC, LGC)
Entity Type:Individual
Prefix:
First Name:ELICIA
Middle Name:ANN
Last Name:ESTRELLA
Suffix:
Gender:F
Credentials:MS, CGC, LGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-919-4552
Mailing Address - Fax:617-730-0253
Practice Address - Street 1:BOSTON CHILDREN'S HOSPITAL
Practice Address - Street 2:3 BLACKFAN CIRCLE, CLS 15
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-919-4552
Practice Address - Fax:617-730-0253
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC085170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS