Provider Demographics
NPI:1013747690
Name:AGUIRRE, ELIANNA ALTAGRACIA
Entity type:Individual
Prefix:
First Name:ELIANNA
Middle Name:ALTAGRACIA
Last Name:AGUIRRE
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 1:92A GARIBALDI AVE
Mailing Address - Street 2:
Mailing Address - City:ROSETO
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1328
Mailing Address - Country:US
Mailing Address - Phone:201-253-5116
Mailing Address - Fax:
Practice Address - Street 1:109 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2505
Practice Address - Country:US
Practice Address - Phone:610-599-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)