Healthcare Provider Details

I. General information

NPI: 1588471734
Provider Name (Legal Business Name): ELIZABETH ANDERSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N MAIN ST FL 5
ATTLEBORO MA
02703-2282
US

IV. Provider business mailing address

2070 COUNTY ST APT 17
ATTLEBORO MA
02703-8173
US

V. Phone/Fax

Practice location:
  • Phone: 508-409-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: