Provider Demographics
NPI:1861042814
Name:SAROUFIM, ELIE TONY
Entity Type:Individual
Prefix:MR
First Name:ELIE
Middle Name:TONY
Last Name:SAROUFIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 WESTOVER ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1342
Mailing Address - Country:US
Mailing Address - Phone:617-435-5858
Mailing Address - Fax:
Practice Address - Street 1:96 WESTOVER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02132-1342
Practice Address - Country:US
Practice Address - Phone:617-435-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health