Provider Demographics
NPI:1992223234
Name:CHAMPI TELLO, ELIAS SIMON (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:SIMON
Last Name:CHAMPI TELLO
Suffix:
Gender:M
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3069
Mailing Address - Country:US
Mailing Address - Phone:508-849-5600
Mailing Address - Fax:
Practice Address - Street 1:81 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3069
Practice Address - Country:US
Practice Address - Phone:508-849-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker