Provider Demographics
NPI:1154760544
Name:SETRAKIAN, LENA M
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:M
Last Name:SETRAKIAN
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 1:111 W HIGH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5529
Mailing Address - Country:US
Mailing Address - Phone:410-620-0008
Mailing Address - Fax:410-620-1999
Practice Address - Street 1:111 W HIGH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5529
Practice Address - Country:US
Practice Address - Phone:410-620-0008
Practice Address - Fax:410-620-1999
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional