Provider Demographics
NPI:1942909213
Name:BELETIC, ELISE JULIET (MACCHM, DIPL OM, LA)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:JULIET
Last Name:BELETIC
Suffix:
Gender:F
Credentials:MACCHM, DIPL OM, LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2434
Mailing Address - Country:US
Mailing Address - Phone:805-443-0083
Mailing Address - Fax:
Practice Address - Street 1:500 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1541
Practice Address - Country:US
Practice Address - Phone:207-200-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist