Provider Demographics
NPI:1932524493
Name:SEYMOUR, ELISE (M ED)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:VAN GALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:89 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-3105
Mailing Address - Country:US
Mailing Address - Phone:617-962-7342
Mailing Address - Fax:
Practice Address - Street 1:3 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4273
Practice Address - Country:US
Practice Address - Phone:617-962-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA12925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health