Provider Demographics
NPI:1649321142
Name:PIONTEK, ELLEN S BETTMANN (MED)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:S BETTMANN
Last Name:PIONTEK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MELLEN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1137
Mailing Address - Country:US
Mailing Address - Phone:508-429-6125
Mailing Address - Fax:508-429-9204
Practice Address - Street 1:170 MELLEN ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1137
Practice Address - Country:US
Practice Address - Phone:508-429-6125
Practice Address - Fax:508-429-9204
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2033921041C0700X
MA316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist