Provider Demographics
NPI:1982873261
Name:BOOSALIS, ELENI M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELENI
Middle Name:M
Last Name:BOOSALIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8401 DORSEY CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8303
Mailing Address - Country:US
Mailing Address - Phone:703-408-6142
Mailing Address - Fax:703-656-4868
Practice Address - Street 1:8401 DORSEY CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8303
Practice Address - Country:US
Practice Address - Phone:703-408-6142
Practice Address - Fax:703-656-4868
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist