MEDICARE: ELLENA GRSKOVIC 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	101YM0800X	Mental Health Counselor	120980	MA

General Provider Information

NPI Number	:	1952741225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLENA GRSKOVIC LICSW

Provider Business Mailing Address
First Line	:	36 APPLETON ST APT 1
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-6245
Country	:	US
Telephone Number	:	201-400-0320
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 BOYLSTON ST STE 900
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-3305
Country	:	US
Telephone Number	:	857-285-3816
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	09/30/2020

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