MEDICARE: MS. ELIZABETH ROSE ANDERSON MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	116110	MA

General Provider Information

NPI Number	:	1407016785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ROSE ANDERSON MSW, LICSW

Provider Business Mailing Address
First Line	:	15 EAST ST # 2
Second Line	:
City	:	EASTHAMPTON
State	:	MA
Zip	:	01027-1209
Country	:	US
Telephone Number	:	413-247-4972
Fax Number	:	617-380-4578

Provider Business Practice Location Address
First Line	:	116 PLEASANT ST STE 331
Second Line	:
City	:	EASTHAMPTON
State	:	MA
Zip	:	01027-2756
Country	:	US
Telephone Number	:	413-247-4972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	11/22/2024

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