Provider Demographics
NPI:1760684484
Name:SUZOR, ELAINE C
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:C
Last Name:SUZOR
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:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-0289
Mailing Address - Country:US
Mailing Address - Phone:207-843-5649
Mailing Address - Fax:207-843-7429
Practice Address - Street 1:11 FERNWOOD RD.
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:ME
Practice Address - Zip Code:04429
Practice Address - Country:US
Practice Address - Phone:207-843-5649
Practice Address - Fax:207-843-7429
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME215875171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator