Provider Demographics
NPI:1891231072
Name:AYOTTE, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:AYOTTE
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 1:148 AYERS RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224-2201
Mailing Address - Country:US
Mailing Address - Phone:774-277-0883
Mailing Address - Fax:
Practice Address - Street 1:26 INGELL ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3505
Practice Address - Country:US
Practice Address - Phone:774-277-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3506-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst