Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 117540 | MA |
NPI | 1003225657 |
---|---|
Provider Name | Ms. Mary Beth Elliott |
First Address | Westwood, MA 02090-1322 |
Second Address | Westwood, MA 02090-2903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |