Provider Demographics
NPI:1104241694
Name:BARBOSA, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:BARBOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED
Mailing Address - Street 1:10 ORCHARD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6503
Mailing Address - Country:US
Mailing Address - Phone:845-496-5103
Mailing Address - Fax:
Practice Address - Street 1:10 ORCHARD LAKE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6503
Practice Address - Country:US
Practice Address - Phone:845-496-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator