Provider Demographics
NPI:1821073586
Name:TSAVOUSSIS, ELEFTHERIA (PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:ELEFTHERIA
Middle Name:
Last Name:TSAVOUSSIS
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BEAR HILL ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:781-966-0070
Mailing Address - Fax:781-915-0755
Practice Address - Street 1:210 BEAR HILL ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-966-0070
Practice Address - Fax:781-915-0755
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175264363L00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP33046Medicare UPIN
MANP3288Medicare ID - Type Unspecified