Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MA | |
N | 1041C0700X | Clinical Social Worker |
NPI | 1003137985 |
---|---|
Provider Name | Heather Elliott |
First Address | Westfield, MA 01085-4598 |
Second Address | Petersham, MA 01366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1300881 | (05) | MA |