Eltz, Michael J

Eltz, Michael J is an sole proprietor health care provider with primary practice located at 765 Allens Ave , Providence RI 02905-5443. He recently has 3 registered licenses in different health care specialties including Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children, Agencies / Community/Behavioral Health, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Eltz, Michael J can be contacted via phone (401) 714-7440.

Contact Information

Primary practice address
765 Allens Ave Providence RI 02905-5443
Phone: (401) 714-7440
Fax: (401) 490-2619
Website:
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Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X
Agencies / Community/Behavioral Health 251S00000X PS00748 Rhode Island
Behavioral Health & Social Service Providers / Psychologist 103T00000X PS00748 Rhode Island

Profile Details

NPI number 1639131360
LBN Legal business name Eltz, Michael J
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 6th, 2006
Last updated Feb 20th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639131360 NPPES
Rhode Island MEDICAID ME37214

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