Healthcare Provider Details

I. General information

NPI: 1043316649
Provider Name (Legal Business Name): ELIZABETH SCOTT WARNER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LEXINGTON STREET SUITE 203
AUBURNDALE MA
02466
US

IV. Provider business mailing address

8 CATAUMET ST
JAMAICA PLAIN MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 857-576-0577
  • Fax:
Mailing address:
  • Phone: 857-576-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: