1568525327 NPI number — ELIZABETH ANN SPAULDING LICSW MA 113010

Table of content: ELIZABETH ANN SPAULDING LICSW MA 113010 (NPI 1568525327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568525327 NPI number — ELIZABETH ANN SPAULDING LICSW MA 113010

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAULDING
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW MA 113010
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEARY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW MA 113010
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568525327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 FERRY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-837-6281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 FERRY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-837-6281
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  113011 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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