Healthcare Provider Details

I. General information

NPI: 1528167665
Provider Name (Legal Business Name): ELIZABETH-ANN SOCCORSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWERS ST
BEVERLY MA
01915-2748
US

IV. Provider business mailing address

100 POWERS ST
BEVERLY MA
01915-2748
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-3000
  • Fax: 978-524-6072
Mailing address:
  • Phone: 978-922-3000
  • Fax: 978-524-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number129052
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: