Provider Demographics
NPI:1881666733
Name:ELOVITZ, GERALD PAUL (DED)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PAUL
Last Name:ELOVITZ
Suffix:
Gender:M
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 SANTUIT-NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2509
Mailing Address - Country:US
Mailing Address - Phone:508-420-9989
Mailing Address - Fax:
Practice Address - Street 1:1860 SANTUIT-NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-2509
Practice Address - Country:US
Practice Address - Phone:508-420-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2591103G00000X
RIPS00396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist